Joint assessment of intended and unintended effects of medications: an example using vascular endothelial growth factor inhibitors for neovascular age-related macular degeneration

Levy, A.R., Szabo, S., Briggs, A. , Pleil, A., Davie, A., Zlateva, G. and Javitt, J. (2009) Joint assessment of intended and unintended effects of medications: an example using vascular endothelial growth factor inhibitors for neovascular age-related macular degeneration. Journal of Ophthalmology, 2009, 540431. (doi:10.1155/2009/540431) (PMID:20339464) (PMCID:PMC2836847)

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Abstract

Objective. To estimate the net health benefits of pegaptanib and ranibizumab by considering the impact of visual acuity and unintended effects (cardiovascular and hemorrhagic events) on quality-of-life among persons with neovascular age-related macular degeneration. Methods. We designed a probabilistic decision-analytic model using published data. It employed 17 visual health states and three for unintended effects. We calculated incremental net health benefits by subtracting the harms of each medication from the benefit using the quality-adjusted life year (QALY). Results. In a hypothetical cohort of 1,000 75-year olds with new-onset bilateral age-related macular degeneration followed for ten years, the mean QALYs per patient is 3.7 for usual care, 4.2 for pegaptanib, and 4.3 for ranibizumab. Net benefits decline with increasing baseline rates of unintended effects. Interpretation. Net health benefits present a quantitative, potentially useful tool to assist patients and ophthalmologists in balancing the benefits and harms of interventions for age-related macular degeneration.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Briggs, Professor Andrew
Authors: Levy, A.R., Szabo, S., Briggs, A., Pleil, A., Davie, A., Zlateva, G., and Javitt, J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Centre for Population and Health Sciences
Journal Name:Journal of Ophthalmology
Publisher:Hindawi Publishing Corporation
ISSN:2090-004X
ISSN (Online):2090-0058
Published Online:10 February 2010
Copyright Holders:Copyright © 2009 The Authors
First Published:First published in Journal of Ophthalmology 2009:540431
Publisher Policy:Reproduced under a Creative Commons License

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