Key Points

•The Patient Protection and Affordable Care Act of 2010 funded the Patient-Centered Outcomes Research Institute to promote the use of comparative effectiveness analysis and costeffectiveness analysis in the Unites States.

•There are four healthcare economic analysis variants: (1) cost-minimization analysis, (2) cost-benefit analysis, (3) cost-effectiveness analysis, and (4) cost-utility analysis. Costutility analysis, which uses the outcome $/ QALY (dollars expended per QALY gained) is the most sophisticated.

•The comparative effectiveness, or human value gain conferred by an intervention can be objectively measured using the QALY (quality-adjusted life year).

•Most commonly, only the direct ophthalmic medical costs of therapy for neovascular agerelated macular degeneration (AMD) are addressed in the literature. Societal costs are more desirable.

•Intravitreal ranibizumab therapy versus no therapy for subfoveal neovascular AMD confers

a 15.9–28.2% value gain (improvement in the quality of life), intravitreal bevacizumab with intraocular brachytherapy a 22.4% value gain, photodynamic therapy an 8.1% value gain, intravitreal pegaptanib a 5.9% value gain, and laser therapy a 4.4% value gain. Extrafoveal laser photocoagulation confers an 8.1% value gain over no therapy.

•US interventions costing <$100,000/QALY are usually considered cost-effective, and those costing <$50,000/QALY very cost-effective.

•The direct nonophthalmic medical costs (depression, trauma), direct nonmedical costs (caregiver, shelter, transportation), and indirect costs (decreased salary, decreased incidence of employment) associated with neovascular AMD exceed the direct ophthalmic costs associated with treating neovascular AMD by several hundred percent.

•Untreated atrophic AMD causes an estimated annual wage loss of $26.1 billion (2010 real US dollars) and untreated neovascular AMD results in an annual wage loss of $5.8 billion, for a total wage loss of $31.9 billion (2010 real US dollars). This is essentially a loss to the GDP, since consumer spending is the most important component of the GDP.

G.C. Brown (*)

Department of Ophthalmology, Jefferson Medical College, 910 E. Willow Grove Ave., Wyndmoore, PA 19038, USA

Center for Value-Based Medicine, 6010 Mill Road, Flourtown, PA 19031, USA

e-mail: gary0514@gmail.com

Introduction

The economics of age-related macular degeneration (AMD) is typically discussed with regard to the direct ophthalmic medical costs associated