Cost-effectiveness of Anti-VEGF treatments for age-related macular degeneration: a Brazilian perspective / Estudo de custo-efetividade de tratamentos para a degeneração macular relacionada à idade: uma perspectiva brasileira

ABSTRACT Purpose: To study the cost-effectiveness of ranibizumab and bevacizumab for the treatment of age-related macular degeneration. Methods: We used a decision tree model to analyze the cost-effectiveness of ranibizumab and bevacizumab for the treatment of age-related macular degeneration, from the Brazilian Public Health System (SUS) perspective. Ranibizumab and bevacizumab were administered to patients with the same treatment procedure, and the difference in treatment costs was calculated based on the cost of the drugs. Direct costs were estimated using the information provided by the Brazilian SUS. Effectiveness in terms of quality-adjusted life years (QALYs) was calculated based on the utility values for visual impairment. Incremental cost-effectiveness ratio was calculated by comparing both treatments. The analytical horizon was one year. Results: The decision tree analysis showed that the difference in treatment effectiveness was 0.01 QALY. Incremental cost-effectiveness ratio showed that ranibizumab treatment required an incremental annual cost of more than R$ 2 million to generate 1 additional QALY, as compared to bevacizumab. Conclusions: From the Brazilian SUS perspective, bevacizumab is more cost-effective than ranibizumab for the treatment of neovascular age-related macular degeneration. Its use could allow potential annual savings in health budget.

RESUMO Objetivo: Estudar o custo-efetividade do ranibizumabe e bevacizumabe no tratamento da degeneração macular relacionada à idade neovascular. Métodos: Utilizamos um modelo de árvore de decisão para analisar a relação custo-efetividade do ranibizumabe e bevacizumabe no tratamento da degeneração macular relacionada à idade, sob a perspectiva do Sistema Único de Saúde. O ranibizumabe e bevacizumabe foram administrados a pacientes com o mesmo procedimento de tratamento, e a diferença nos custos do tratamernto foi calculada com base no custo dos medicamentos. Os custos diretos foram estimados utilizando as informações fornecidas pelo SUS. A efetividade foi determinada em anos de vida ajustados pela qualidade (QALY) baseados em valores de utilidade em deficiênciavisual. A razãoincremental custo-efetividadefoicalculada comparando os dois tratamentos. O horizonte analítico foi de um ano. Resultados: A análise da árvore de decisão mostrou que a diferença na efetividade do tratamento foi de 0,01 QALY. A razão incremental de custo-efetividade mostrou que o tratamento com ranibizumabe exigiu um custo anual incremental de R$ 2 milhões para gerar um QALY adicional, em comparação ao bevacizumabe. Conclusões: Do ponto de vista do SUS, o bevacizumabe é mais custo-efetivo que o ranibizumabe no tratamento da degeneração macular relacionada à idade neovascular. O seu uso poderia gerar uma grande economia anual para o orçamento em saúde.

Costo-efectividad de una alternativa para la prestación de servicios de atención primaria en salud para los beneficiarios del Seguro Popular de México / Cost-effectiveness analysis of an alternative for the provision of primary health care for beneficiaries of Seguro Popular in Mexico

Resumen: Objetivo: Calcular la razón costo-efectividad de servicios públicos y privados contratados por el Seguro Popular en primer nivel de atención. Material y métodos: Se evaluó una experiencia piloto de contratación de servicios de primer nivel de atención a la salud en el estado de Hidalgo, México, midiendo, con base en una encuesta poblacional, la calidad general y la detección de disminución de visión. Se analizó la sensibilidad mediante simulaciones de Monte Carlo. Resultados: El prestador privado es dominante en calidad y costo-efectivo para la detección de disminución de visión. Conclusiones: La compra estratégica de prestadores privados de atención primaria es promisoria para mejorar los servicios de salud y reducir los costos.

Abstract: Objective: To estimate the cost-effectiveness ratio of public and private health care providers funded by Seguro Popular. Materials and methods: A pilot contracting primary care health care scheme in the state of Hidalgo, Mexico, was evaluated through a population survey to assess quality of care and detection decreased of vision. Costs were assessed from the payer perspective using institutional sources.The alternatives analyzed were a private provider with capitated and performance-based payment modalities, and a public provider funded through budget subsidies. Sensitivity analysis was performed using Monte Carlo simulations. Results: The private provider is dominant in the quality and cost-effective detection of decreased vision. Conclusions: Strategic purchasing of private providers of primary care has shown promising results as an alternative to improving quality of health services and reducing costs.

What the comprehensive economics of blindness and visual impairment can help us understand.

Since the year 2000, the amount written about the economics of blindness and visual impairment has increased substantially. In some cases, the studies listed under this heading are calculations of the costs related to vision impairment and blindness at a national or global level; in other cases the studies examine the cost-effectiveness of strategies to prevent or modify visual impairment or blindness that are intended to be applied as a guide to treatment recommendations and coverage decisions. In each case the references are just examples of many that could be cited. These important studies have helped advocates, policy makers, practitioners, educators, and others interested in eye and vision health to understand the magnitude of the impact that visual impairment and blindness have on the world, regions, nations, and individuals and the tradeoffs that need to be made to limit the impact. However, these studies only begin to tap into the insights that economic logic might offer to those interested in this field. This paper presents multiple case studies that demonstrate that the economics of blindness and visual impairment encompasses much more than simply measures of the burden of the condition. Case studies demonstrating the usefulness of economic insight include analysis of the prevention of conditions that lead to impairment, decisions about refractive error and presbyopia, decisions about disease and injury treatment, decisions about behavior among those with uncorrectable impairment, and decisions about how to regulate the market all have important economic inputs.