Abstract:
PURPOSE:We sought to determine the most cost-effective treatment for patients with newly diagnosed neovascular macular degeneration: monthly or as-needed bevacizumab injections, or monthly or as-needed ranibizumab injections. DESIGN:Cost-effectiveness analysis. PARTICIPANTS:Hypothetical cohort of 80-year-old patients with newly diagnosed neovascular macular degeneration. METHODS:Using a mathematical model with a 20-year time horizon, we compared the incremental cost-effectiveness of treating a hypothetical cohort of 80-year-old patients with newly diagnosed neovascular macular degeneration using monthly bevacizumab, as-needed bevacizumab, monthly ranibizumab, or as-needed ranibizumab. Data came from the Comparison of Age-related macular degeneration Treatment Trial (CATT), the Medicare Fee Schedule, and the medical literature. MAIN OUTCOME MEASURES:Costs, quality-adjusted life-years (QALYs), and incremental costs per QALY gained. RESULTS:Compared with as-needed bevacizumab, the incremental cost-effectiveness ratio of monthly bevacizumab is $24,2 357/QALY. Monthly ranibizumab gains an additional 0.02 QALYs versus monthly bevacizumab at an incremental cost-effectiveness ratio of >$10 million/QALY. As-needed ranibizumab was dominated by monthly bevacizumab, meaning it was more costly and less effective. In sensitivity analyses assuming a willingness to pay of $100,000/QALY, the annual risk of serious vascular events would have to be ≥2.5 times higher with bevacizumab than that observed in the CATT trial for as-needed ranibizumab to have an incremental cost-effectiveness ratio of <$100,000/QALY. In another sensitivity analysis, even if every patient receiving bevacizumab experienced declining vision by 1 category (e.g., from 20/25-20/40 to 20/50-20/80) after 2 years but every patient receiving ranibizumab retained their vision level, as-needed ranibizumab would have an incremental cost-effectiveness ratio of $97,340/QALY. CONCLUSIONS:Even after considering the potential for differences in risks of serious adverse events and therapeutic effectiveness, bevacizumab confers considerably greater value than ranibizumab for the treatment of neovascular macular degeneration.
journal_name
Ophthalmologyjournal_title
Ophthalmologyauthors
Stein JD,Newman-Casey PA,Mrinalini T,Lee PP,Hutton DWdoi
10.1016/j.ophtha.2013.10.037subject
Has Abstractpub_date
2014-04-01 00:00:00pages
936-45issue
4eissn
0161-6420issn
1549-4713pii
S0161-6420(13)01043-9journal_volume
121pub_type
杂志文章相关文献
OPHTHALMOLOGY文献大全abstract:OBJECTIVES:To determine the anatomic and functional outcomes of photorefractive surgery in patients with underlying systemic diseases that are traditionally listed as relative or absolute contraindications. DESIGN:Observational retrospective case-control study. PARTICIPANTS:The case groups were composed of 275 eyes o...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/j.ophtha.2006.02.023
更新日期:2006-07-01 00:00:00
abstract:PURPOSE:To quantify factors affecting test-retest variability of threshold measurements over a series of 3 serial visual fields (VF). DESIGN:Prospective comparative observational study. PARTICIPANTS:Forty-one normals, 10 suspects and 35 stable glaucoma patients. METHODS:All subjects performed 3 standard and 3 short-...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/S0161-6420(03)00541-4
更新日期:2003-10-01 00:00:00
abstract::The effectiveness of trabeculectomy with adjunctive low-dose 5-fluorouracil (5-FU) as the initial surgical procedure in uncomplicated glaucoma was evaluated retrospectively in a consecutive series of 52 patients (mean follow-up, 18.6 +/- 11.7 mos) and 74 control subjects. The cumulative 2-year success (intraocular pre...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/s0161-6420(91)32180-8
更新日期:1991-07-01 00:00:00
abstract:BACKGROUND:Suprachoroidal hemorrhage may cause the expulsion of intraocular contents. Generally, cases of nonexpulsive suprachoroidal hemorrhage have a better outcome than their expulsive counterparts. Those cases with massive nonexpulsive suprachoroidal hemorrhage do better with treatment than without. Treatment modal...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/s0161-6420(92)31756-7
更新日期:1992-10-01 00:00:00
abstract::The clinical features of 290 patients with scleral inflammation were reviewed to determine whether a classification based on the anatomical site and clinical appearance of the disease at presentation reflected its natural history. The authors' results confirm that the majority of patients remain in the same clinical c...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/s0161-6420(91)32269-3
更新日期:1991-04-01 00:00:00
abstract:PURPOSE:To characterize retinal pigment epithelial (RPE) cell loss as evidenced by autofluorescence imaging in patients with neovascular age-related macular degeneration (AMD). DESIGN:Retrospective cohort study. PARTICIPANTS:There were 162 eyes of 116 consecutive patients with neovascular AMD examined in a retinal pr...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/j.ophtha.2012.07.076
更新日期:2013-02-01 00:00:00
abstract:PURPOSE:To calculate the relationship between Medicare payment and service volume for the 3 highest-volume retina procedures: intravitreal injection (Current Procedural Terminology [CPT] code 67028), laser treatment for retinal edema (CPT code 67210), and laser treatment for proliferative retinopathy (CPT code 67228). ...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/j.ophtha.2015.04.040
更新日期:2015-08-01 00:00:00
abstract::Ten patients, all younger than 50 years of age, had a temporal cilioretinal artery occlusion associated with a nonischemic central retinal vein occlusion. On fluorescein angiography, the cilioretinal artery eventually filled in all but one eye. The cilioretinal artery showed pulsations on fluorescein angiography in fi...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/s0161-6420(91)32245-0
更新日期:1991-05-01 00:00:00
abstract:PURPOSE:To report the results of the first 2 years of experience with an American Academy of Ophthalmology (AAO) cataract surgery registry; to compare patient characteristics, operative procedures, and patient outcomes observed in the registry to those observed in the Cataract PORT study; and to discuss the current sho...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/s0161-6420(99)00184-0
更新日期:2000-04-01 00:00:00
abstract:OBJECTIVE:To compare the safety and intraocular pressure (IOP)-lowering efficacy of once-daily travoprost (0.0015% and 0.004%) to twice-daily timolol 0.5%. DESIGN:Prospective, 6-month, randomized, controlled, multicenter, double-masked, phase III study. PARTICIPANTS:Six hundred five patients with open-angle glaucoma ...
journal_title:Ophthalmology
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/s0161-6420(02)01010-2
更新日期:2002-05-01 00:00:00
abstract:PURPOSE:The purpose of the study was to determine long-term results of involutional entropion repair by a modified corncrib (inverted T) procedure with a Quickert suture. METHODS:A retrospective review of consecutive patients with involutional entropion who underwent repair by a modified corncrib procedure from Januar...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/s0161-6420(97)30284-x
更新日期:1997-03-01 00:00:00
abstract:PURPOSE:To report the 3-month results of a randomized trial (Femtosecond Laser-Assisted Cataract Trial [FACT]) comparing femtosecond laser-assisted cataract surgery (FLACS) with standard phacoemulsification cataract surgery (PCS). DESIGN:Multicenter, randomized controlled trial funded by the UK National Institute of H...
journal_title:Ophthalmology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.ophtha.2020.02.028
更新日期:2020-08-01 00:00:00
abstract::Many techniques for repositioning dislocated posterior chamber implants described in the recent literature involve intricate intraocular manipulation of a needle or other sharp instrument. The author describes an improved sulcus fixation technique, which combines the best features of external and internal approaches. ...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/s0161-6420(92)32012-3
更新日期:1992-01-01 00:00:00
abstract::Seventeen patients having a posterior uveal melanoma underwent enucleation following documentation of tumor growth. Duration of follow-up from diagnosis to enucleation ranged from 3 weeks to 30 months. The mean rate of enlargement in cubic tumor volume was 56.3 mm3/mo for eight spindle cell melanomas and 270.3 mm3/mo ...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/s0161-6420(84)34088-x
更新日期:1984-12-01 00:00:00
abstract:BACKGROUND:Dislocation of nuclear lens fragments during phacoemulsification can lead to a high incidence of glaucoma, uveitis, and poor visual acuity. The correct approach to these patients is uncertain. The authors report on eight patients who underwent pars plana vitrectomy with removal of lens fragments. METHODS:Ch...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/s0161-6420(92)31805-6
更新日期:1992-08-01 00:00:00
abstract::The authors' experience over the past five years in the cryosurgical management of retinal detachment in ten eyes of eight premature infants with retrolental fibroplasia, whose ages at the time of detachment surgery ranged from 2 1/2 months to 11 months with an average of 5 1/2 months, is reported. Postoperative follo...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/s0161-6420(79)35436-7
更新日期:1979-05-01 00:00:00
abstract:BACKGROUND:Patients at risk for retinol deficiency in developed countries include those with hepatic dysfunction and malabsorption states. Symptoms of retinol deficiency may go unrecognized or unreported. METHODS:The authors describe 15 patients with hepatic dysfunction, two of whom had procedures that would predispos...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/s0161-6420(94)38029-8
更新日期:1994-06-01 00:00:00
abstract:PURPOSE:This study aimed to identify the genetic defects in 2 families with autosomal recessive macular dystrophy with central cone involvement. DESIGN:Case series. PARTICIPANTS:Two families and a cohort of 244 individuals with various inherited maculopathies and cone disorders. METHODS:Genome-wide linkage analysis ...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/j.ophtha.2014.07.040
更新日期:2015-01-01 00:00:00
abstract::We studied the macrostructural characteristics of papillary changes of the upper tarsal conjunctiva associated with the wearing of polymethyl methacrylate (PMMA) contact lenses. Fifty subjects with elevated conjunctival papillae greater than 0.3 mm in diameter were studied. Macrostructural characteristics recorded wer...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/s0161-6420(81)34899-4
更新日期:1981-11-01 00:00:00
abstract:OBJECTIVE:The aims of this study were to describe the clinical features and biometric findings in the eyes of children with coloboma and to develop a classification of coloboma that correlates with visual function. DESIGN:Retrospective observational case series. PARTICIPANTS:One hundred thirteen children and young ad...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/s0161-6420(99)00140-2
更新日期:2000-03-01 00:00:00
abstract::The authors conducted a multicenter, randomized, controlled trial to test whether the Schocket shunt with a larger shunt reservoir surface area would provide a lower final intraocular pressure than the double-plate Molteno implant. However, the Molteno implant produced a statistically lower intraocular pressure at 6 m...
journal_title:Ophthalmology
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/s0161-6420(92)31911-6
更新日期:1992-05-01 00:00:00
abstract::Thirteen keratophakia patients were followed for 13 to 35 months. Eighteen cases of hyperopic keratomileusis or hyperopic keratomileusis using preserved corneal tissue were followed for 2 to 30 months. All 13 patients who underwent keratophakia achieved 20/50 or better acuity. All seven patients having hyperopic kerat...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/s0161-6420(81)34957-4
更新日期:1981-08-01 00:00:00
abstract::Long-term follow-up was recorded on the visual fields of 251 patients with chronic open-angle glaucoma and 826 patients with ocular hypertension. Observation periods exceeded ten years for 73 patients with manifest glaucoma. Initial glaucomatous defects appeared in 98 eyes of 72 patients while under continuous observa...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/s0161-6420(82)34798-3
更新日期:1982-03-01 00:00:00
abstract::An 80-year-old man was evaluated for an epibulbar tumor on a phthisical eye. The initial biopsy diagnosis of the epibulbar tumor was poorly differentiated neoplasm. Exenteration of the phthisical eye and orbital contents showed an extensive pleomorphic adenocarcinoma of the nonpigmented epithelium of the ciliary body ...
journal_title:Ophthalmology
pub_type: 杂志文章,评审
doi:10.1016/s0161-6420(90)32522-8
更新日期:1990-06-01 00:00:00
abstract:OBJECTIVE:To report 3 patients with type I osteogenesis imperfecta (OI) who developed retinal hemorrhages and subdural hematomas after minor trauma. DESIGN:Observational case series. METHOD:Children with OI who developed retinal hemorrhages after minor trauma were identified through an international e-mail-based mail...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/j.ophtha.2003.10.028
更新日期:2004-07-01 00:00:00
abstract:BACKGROUND:After a failed buckle surgery, the second procedure tends to be a gas injection and the third a vitrectomy. METHODS:The failures from two series, consisting of 752 and 500 buckle surgeries, were analyzed for cause, solution, and outcome after repeat surgery with a segmental or encircling buckle. RESULTS:Th...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/s0161-6420(96)30459-4
更新日期:1996-10-01 00:00:00
abstract:BACKGROUND:Opportunistic infections frequently involve the anterior and posterior segments of the eye but rarely occur in the orbit in patients with human immunodeficiency virus (HIV) infection. The authors managed eight patients with HIV and unilateral orbital infections who presented between July 1988 and March 1995....
journal_title:Ophthalmology
pub_type: 杂志文章,评审
doi:10.1016/s0161-6420(96)30479-x
更新日期:1996-09-01 00:00:00
abstract::Automated perimetry is used to monitor changes associated with many ocular conditions such as glaucoma, neuro-ophthalmologic disorders, and retinal diseases. Comparisons among sequential visual fields are crucial to the determination of progression or regression of ocular anomalies, and to evaluate the efficacy of var...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/s0161-6420(88)33203-3
更新日期:1988-02-01 00:00:00
abstract::The retinal nerve fiber layer is different in normal and glaucomatous eyes. The authors used red-free photographs to examine the retinal nerve fiber layer in 234 normal eyes. The retinal nerve fiber layer was most visible in the inferior temporal arcade, followed by the superior temporal arcade, then by the temporal m...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/s0161-6420(89)32838-7
更新日期:1989-05-01 00:00:00
abstract:PURPOSE:To describe the clinical features and to present results of new diagnostic methods to help define the cause of the clinical syndrome of intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage (IHAPSH). DESIGN:Retrospective review of patients with IHAPSH at presentation seen in 3 centers in ...
journal_title:Ophthalmology
pub_type: 杂志文章
doi:10.1016/j.ophtha.2003.08.040
更新日期:2004-05-01 00:00:00