Table 10.10 Caregiver costs associated with age-related macular degeneration (adjusted TO 2010 real US dollars)

Adapted from data in Schmier et al. [69]

Pearl

Among AMD patients with 20/250 or less vision, the annual caregiver costs exceed $58,000per year.

Among the indirect costs encountered in AMD patients with visual loss are those associated with lack of employment and decreased salary, as discussed above. The costs associated with volunteering should also be theoretically included, preferably at the average national wage per hour, but data in this arena are sparse. Disability costs are relevant for the patient and governmental perspectives, although some believe they are transfer costs, and thus should not be used in a societal cost perspective, cost-utility analysis [24].

Financial Return on Investment (ROI)

Brown and colleagues [13] demonstrated that brachytherapy/VEGF-A inhibitor therapy for neovascular AMD accrues a 16.2% annual financial return on investment (ROI) for the direct ophthalmic medical costs expended. Furthermore, this therapy adds $76,000 per capita to the GDP above the direct ophthalmic medical costs expended over the 13-year life expectancy of the average patient.

Data from the Center for Value-Based Medicine® suggest that ranibizumab therapy for neovascular AMD accrues four times over and above the direct, ophthalmic medical costs of approximately $51,000 expended over the 12-year life expectancy of the average patient in the MARINA [Minimally classic/occult trial of

the Anti-VEGF antibody Ranibizumab In the treatment of Neovascular Age-Related Macular Degeneration (AMD)] Study [32, 70].

Pearl

Intravitreal ranibizumab therapy for neovascular AMD returns approximately $4 to society for every $1 it consumes in direct ophthalmic medical cost.

Approximately, 1,65,000 people each year develop neovascular AMD in the USA. Assuming each is treated with ranibizumab as per the MARINA trial [32], the total cost would be $8.4 billion. Nonetheless, an economic analysis suggests that ranibizumab therapy returns a net $25 billion in wages generated and costs saved above the direct costs of ranibizumab therapy over the 12-year model [70]. This is an extraordinary ROI that creates considerable wealth for the country at the same time it greatly enhances human value [70]. It is safe to say that very few interventions in the last decade have conferred human value gain and financial value gain close to that of ranibizumab for neovascular AMD. The impact of the intervention is extraordinary.

Financial Disclosure Supported in part by the Center for Value-Based Medicine®, Flourtown, PA, the sponsor played no role in performance of the study, writing of the manuscript, or requiring direction of the study.

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