Comparative Effectiveness and Cost-Effectiveness of the Implantable Miniature Telescope

Brown, Gary C.; Brown, Melissa M.; Lieske, Heidi B.; Lieske, Philip A.; Brown, Kathryn; Lane, Stephen S.

doi:10.1016/j.ophtha.2011.02.012

Cited by 27 publications

(20 citation statements)

References 28 publications

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“…Nonetheless, each treated second-eye patient in the triple therapy with Zx cohort contributed 2.21× the value contributed by a treated first-eye patient. The less favorable, first-eye, vision utility data were taken from the Center for Value-Based Medicine Utility Database [23, 24, 26–34]. …”

Section: Resultsmentioning

confidence: 99%

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Triple combination therapy and zeaxanthin for the treatment of neovascular age-related macular degeneration: an interventional comparative study and cost-effectiveness analysis

et al. 2015

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BackgroundReports of triple combination therapy for neovascular age-related macular degeneration (AMD) suggest a benefit, as do reports for zeaxanthin. An interventional comparative study was thus undertaken to evaluate the efficacy of triple combination therapy with and without zeaxanthin, as well as the economic viability of the therapies.MethodsThe cases of 543 consecutive eyes of 424 patients with subfoveal choroidal neovascularization (CNV) secondary to AMD were reviewed. All eyes were treated with triple combination therapy (triple therapy) consisting of: (1) reduced-fluence photodynamic therapy with verteporfin, (2) intravitreal bevacizumab and (3) intravitreal dexamethasone. Therapy was repeated as necessary. One cohort of patients was also given supplementation with 20 mg of oral zeaxanthin (Zx) daily.ResultsThe triple therapy group without Zx received a mean of 2.8 treatment cycles and 87 % of patients had stable or improved vision at 24 months. In the triple therapy group with Zx, the mean number of treatment cycles was 2.1, with 83 % of patients having stable or improved vision at 24 months. At 24 months, CNV developed in 12.5 % of fellow eyes treated with triple therapy alone; CNV developed in 6.25 % of eyes treated with triple therapy with Zx (p = 0.03). An average cost-utility analysis revealed that triple therapy was cost-effective with a cost-utility ratio of $26,574/QALY, while triple therapy with Zx was more cost-effective with an average cost-utility ratio of $19,962/QALY. The incremental cost-utility analysis assessing the addition of Zx to triple therapy disclosed Zx supplementation was very cost-effective at $5302/QALY. When it was assumed that triple therapy with Zx reduced fellow eye CNV development by 30.3 %, the incremental cost-utility dropped to (−$6332/QALY), indicating that adding Zx to triple therapy yielded greater patient value, and was also less expensive than using triple therapy alone.ConclusionsTriple therapy is comparatively effective and cost-effective. Considerably less treatment is needed than reported in monotherapy studies. The addition of oral Zx appears to further reduce the treatment cycles required, and possibly reduce the risk of CNV development in the fellow eye.

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Section: Resultsmentioning

confidence: 99%

“…Excellent validity [28] and reliability [29] have been demonstrated for these utilities. They have been utilized in numerous peer-reviewed papers by the authors [26, 27, 30–34] and other researchers [35–37]. …”

Section: Methodsmentioning

confidence: 99%

Triple combination therapy and zeaxanthin for the treatment of neovascular age-related macular degeneration: an interventional comparative study and cost-effectiveness analysis

et al. 2015

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“…Patients have experienced improved QoL and general vision (near and distance) as well as improved psychosocial vision-targeted subscales such as social functioning, mental health, and dependency. On average, IMT patients experienced a 12.5% QoL gain [77]. Long-term study data 60 months post-implantation revealed that 47.4% of patients maintained a 3-line gain in vision, while 61.8% maintained a 2-line gain [76].…”

Section: The Imtmentioning

confidence: 95%

The Implantable Miniature Telescope and Quality of Life Improvements in Patients with End-Stage Age-Related Macular Degeneration

Primo¹

2017

J Community Med Health Educ

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Age-related macular degeneration (AMD) is a progressive, degenerative eye disease that leads to central vision loss in people older than 60. End-stage AMD, for which there is no cure, is the leading cause of blindness in highincome countries. Often underappreciated by physicians, AMD is an important public health problem as patients can experience significant emotional distress, reduced cognitive function and a decrease in quality of life from depression, isolation, reduced mobility, and independence. These patients are more likely to suffer from falls and injuries, which may result in serious, life-threatening complications and significant medical costs. There are no medical interventions that can halt the visual outcome of end-stage AMD; patients can only make the best of the vision they have left through low-vision rehabilitation and external devices and tools. In 2010, the U.S. Food and Drug Administration approved the implantable miniature telescope (IMT; VisionCare Ophthalmic Technologies, Saratoga, CA) prosthesis for severely visually impaired patients with bilateral end-stage AMD. Patients with no other treatment options may have improved quality of life after implantation due to visual gains, increased mobility and independence, and improved overall function.

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“…To build-in miniature telescopic implants, the following criteria must be met: both eyes must have end-stage AMD, without a possibility to recover, mainly with already developed fibrovascular complex or geographic atrophy; they did not undergo a cataract surgery on the eye in which a telescopic implant will be built-in, but there is grade 2 cataract, or above; they have good peripheral vision, without changes on the retinal periphery; they are fully trained for the use of outer telescopic systems and they underwent complete training by a sub-specialist in low-vision; they achieve improvement of at least five letters by ETDRS scale with the support of outer telescopic systems; they have fully transparent, healthy retina, with preserved sufficient endothelial cell density, visual acuity 0.025-0.125; and they are over 75 years of age. Such cataract surgical intervention with implantation of the telescopic system in the capsular bag costs about £13,000 (32). …”

Section: Telescopic Intra Ocular Implantsmentioning

confidence: 99%

Therapeutic Modalities of Exudative Age-related Macular Degeneration

Mavija¹,

Alimanovic²,

Jaksic³

et al. 2014

Med Arh

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Introduction:Age-related macular degeneration (AMD) is a leading cause of irreversible serious vision damage in persons over 50 years of age. In treating AMD many medicaments are applied such as inhibitors of vascular endothelial growth factor (VEGF), have been very carefully included over the last few years after a series of study research.Aims:To analyze the past methods of treatment, discuss emerging therapies which could advance the treatment of exudative AMD. The past anti-VEGF therapies require frequent repetitions of administration, with uncertain visual acuity recovery, as not all patients react to anti-VEGF therapy. Consequently, there is a need to find out additional therapies which could improve the treatment of exudative AMD. The real aim in the treating of AMD is to prevent CNV development.Methods:A survey of the current clinical research and results in the field of the present and future treatments of exudative AMD.Results:There are many areas of research into new methods of the exudative AMD treatment.Conclusion:The future therapies for exudative AMD treatment have a potential not only to reduce the frequency of administration and follow-up visits, but also to improve effects of treatment by targeting additional ways of CNV development, increasing the aptitude of target binding and extending durability of treatment.

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Comparative Effectiveness and Cost-Effectiveness of the Implantable Miniature Telescope

Cited by 27 publications

References 28 publications

Triple combination therapy and zeaxanthin for the treatment of neovascular age-related macular degeneration: an interventional comparative study and cost-effectiveness analysis

Triple combination therapy and zeaxanthin for the treatment of neovascular age-related macular degeneration: an interventional comparative study and cost-effectiveness analysis

The Implantable Miniature Telescope and Quality of Life Improvements in Patients with End-Stage Age-Related Macular Degeneration

Therapeutic Modalities of Exudative Age-related Macular Degeneration

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