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IntroductionNeovascular age-related macular degeneration (nAMD) is a chronic eye condition that causes severe deterioration of vision and ultimately blindness. Two vascular endothelial growth factor inhibitors are approved for nAMD treatment in Europe: ranibizumab and aflibercept. The European license for ranibizumab was updated with an individualized “treat and extend” (T&E) regimen, which involves more proactive treatment based on changes in best corrected visual acuity (BCVA) and/or anatomical outcomes. The aim of this publication is to compare the efficacy of the ranibizumab T&E regimen with other approved dosing regimens for nAMD on the basis of outcomes identified from a systematic review and subsequent NMA.MethodsFollowing a systematic search of publications, to identify relevant studies, a repeated-measures network meta-analysis (NMA) was performed to estimate the relative effectiveness of ranibizumab T&E versus approved dosing regimens of ranibizumab and aflibercept. The analysis focused on licensed treatment regimens for nAMD. We examined mean change from baseline in BCVA on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart.ResultsThe systematic literature review identified 22,949 records, of which 23 studies were included in the NMA. At 12 months, the ranibizumab T&E dosing regimen vs ranibizumab pro re nata (PRN) was associated with small differences in change in BCVA, between 1.86 letter gain at 12 months and 2.35 letter gain at 24 months. A similar difference was observed in the aflibercept dosing regimen versus ranibizumab T&E ; 1.94 letter gain at 12 months and 3.31 letter gain at 24 months. All doses of ranibizumab and aflibercept showed similar effectiveness, and the differences between treatment options were not significant.ConclusionThis study used novel repeated-measures NMA to synthesize efficacy results when treatment effects were reported at multiple follow-up times. This repeated-measures NMA suggests that treating patients with the ranibizumab T&E regimen yields similar effectiveness compared to other approved ranibizumab and aflibercept dosing regimens for nAMD treatment. Funding: Novartis Pharmaceuticals UK Ltd, Surrey, UK.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-017-0484-0) contains supplementary material, which is available to authorized users.

Background: For novel migraine therapies, economic evaluations will be required to understand the trade-offs between additional health benefit and additional cost. The purpose of this study was to conduct a systematic literature review (SLR) to identify previous economic evaluations in migraine from the United Kingdom or Irish perspective to critically appraise these evaluations and to propose, if necessary, a novel modelling approach that can be used for future economic evaluations of migraine therapies. Methods: An SLR was conducted to identify previous economic evaluations of preventive migraine treatments. Key opinion leaders were consulted to determine the criteria for a robust migraine economic evaluation. Economic evaluations identified in the SLR were appraised against these criteria, and a novel cost-effectiveness model structure was then proposed. Results: Eight records reporting on published economic evaluations were identified and critically appraised for general quality. Expert consultation provided 6 recommendations on the ideal model structure for migraine that is both clinically and economically meaningful. A decision-tree plus Markov structure was then developed as a cost-effectiveness model for migraine therapies where each health state is associated with a patient distribution across monthly migraine day (MMD) frequencies. Conclusions: Future migraine economic evaluations should allow for assessments across the full spectrum of migraine, a response-based stopping rule, and the estimation of benefits and resource costs based on MMD frequency. The approach proposed in this paper captures all of the desired elements for an economic evaluation of migraine therapy and is suitable to assess new migraine therapies.

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Health technology assessment (HTA) agencies vary in their use of quantitative patient preference data (PP) and the extent to which they have formalized this use in their guidelines. Based on the authors' knowledge of the literature, we identified six different PP “use cases” that integrate PP into HTA in five different ways: through endpoint selection, clinical benefit rating, predicting uptake, input into economic evaluation, and a means to weight all HTA criteria. Five types of insight are distinguished across the use cases: understanding what matters to patients, predicting patient choices, estimating the utility generated by treatment benefits, estimating the willingness to pay for treatment benefits, and informing distributional considerations. Summarizing the literature on these use cases, we recommend circumstances in which PP can add value to HTA and the further research and guidance that is required to support the integration of PP in HTA. Where HTA places more emphasis on clinical outcomes, novel endpoints are available; or where there are already many treatment options, PP can add value by helping decision makers to understand what matters to patients. Where uptake is uncertain, PP can be used to estimate uptake probability. Where indication-specific utility functions are required or where existing utility measures fail to capture the value of treatments, PP can be used to generate or supplement existing utility estimates. Where patients are paying out of pocket, PP can be used to estimate willingness to pay.

A575Objectives: Cataract surgery is the most frequently performed surgical operation in the EU and Nd:YAG laser capsulotomy, a procedure to treat posterior capsular opacification (PCO), is the most commonly reported complication after cataract surgery. The aim of this study was to investigate the incidence of Nd:YAG laser capsulotomy reported in the literature for hydrophobic monofocal AcrySof® IOLs versus non-AcrySof monofocal acrylic IOLs (hydrophilic and hydrophobic). MethOds: Randomized controlled trials (RCTs) were identified through a systematic literature search using Embase®, MEDLINE®, MEDLINE®-In Process, and Cochrane platforms (January 1996 through July 2016). Meta-analyses evaluating the incidence of Nd:YAG capsulotomy at ≤ 1 year, between 1 and 2 years, and > 2 years were conducted comparing AcrySof® IOLs versus non-AcrySof hydrophilic and hydrophobic acrylic IOLs. Subgroup analyses were also conducted between groups. Results: 17 RCTs met the inclusion criteria and were included in the main analysis. AcrySof® IOLs had significantly lower Nd:YAG capsulotomy rates at 1-2 years post-surgery (OR, 0.09; 95%-CI, 0.05 -0.17; p< 0.05) and > 2 years (OR, 0.33; 95%-CI, 0.16 -0.69; p< 0.05) compared to non-AcrySof acrylic IOLs. In the subgroup analysis, AcrySof® IOLs had significantly lower Nd:YAG capsulotomy rates compared to hydrophilic acrylic IOLs at 1-2 years (OR, 0.09; 95%-CI, 0.04 -0.17; p< 0.05) and > 2 years (OR, 0.09; 95%-CI, 0.02 -0.49; p< 0.05). A similar trend was observed vs. non-AcrySof hydrophobic IOLs at > 2 years post-surgery. However, this analysis was limited to a low number of studies (n= 3) and the observed difference did not reach statistical significance (OR, 0.60; 95%-CI,0.25-1.43; p= > 0.05). cOnclusiOns: AcrySof® IOLs are associated with a significantly lower incidence of Nd:YAG capsulotomy compared to non-AcrySof acrylic IOLs (hydrophilic and hydrophobic) and hydrophilic acrylic IOLs at ≥ 2 years, postcataract surgery. Regarding the incidence of Nd:YAG capsulotomy, further research comparing AcrySof® IOLs to non-AcrySof hydrophobic acrylic IOLs is warranted.

For every 10 procedures performed on centrifugal technique, payer is expected to save USD 2595 (VND 60,615,000). Conclusions: The economic evaluation between these two plasma exchange techniques showed centrifugal TPE had a better cost benefit than membrane TPE. For a hospital with similar characteristics, we expect positive economic impact with application of centrifugal TPE.

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