Justifying the Cost of a Retinal Prosthesis in Retinitis Pigmentosa
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Retinitis Pigmentosa (RP) is a hereditary genetic disease causing bilateral retinal degeneration. RP is a leading cause of blindness resulting in incurable visual impairment and drastic reduction in the Quality of life of the patients. Second Sight Medical Products Inc. developed Argus II, a retinal prosthesis system for treating RP. Argus II is the world's first ever-commercial implant intended to restore some vision in the blind patients. The objective of this study was to assess the cost-effectiveness of the Argus® II Retinal Prosthesis System (Argus II) in Retinitis Pigmentosa (RP) patients.
METHOD
A multi -state transition Markov model was developed to determine the cost-effectiveness of Argus II versus usual care in RP from the perspective of healthcare payer. A hypothetical cohort of 1000 RP patients aged 46 years followed up over a (lifetime) 25-year time horizon. Health outcomes were expressed as quality adjusted life years (QALYs) and direct healthcare costs expressed in 2012 €. Results are reported as incremental cost per ratios (ICERs) with outcomes and costs discounted at an annual rate of 3.5%.
RESULTS
The ICER for Argus II was €14,603/QALY. Taking into account the uncertainty in model inputs the ICER was €14,482/QALY in the probabilistic analysis. In the scenarios of an assumption of no reduction on cost across model visual acuity states or a model time horizon as short as 10 years the ICER increased to €31,890/QALY and €49,769/QALY respectively.
CONCLUSION
This economic evaluation shows that Argus II is a cost-effective intervention compared to usual care of the RP patients. The lifetime analysis ICER for Argus II falls below the published societal willingness to pay of EuroZone countries.
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Additional Info
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The Cost-Effectiveness of the Argus II Retinal Prosthesis in Retinitis Pigmentosa Patients
BMC Ophthalmol 2014 May 01;[EPub Ahead of Print], A Vaidya, E Borgonovi, RS Taylor, JA Sahel, S Rizzo, PE Stanga, A Kukreja, P WalterFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
In 2011, a device that could change the lives of people with end-stage retinitis pigmentosa (RP) was approved by the European countries (CE Mark) and 2 years later by the United States (FDA). The Argus II, a retinal prosthesis, arguably has a restricted clientele, but trials with a limited number of patients have shown that the device provides someone who has almost no sight with a black-and-white representation of the world. Seeing this new world has the potential to decrease the feelings of helplessness and depression, allow the user to get around more securely, and positively affect the performance of activities of daily living that were either impossible to do or required assistance.
What is all that worth to an individual with RP? Equally as important, especially with today’s healthcare fiscal concerns, is how will this be valued by third-party payers who will most assuredly be underwriting the expense of this device and all that it entails? In calculating that worth, one must not only consider the device and all of the surrounding costs (which are initially high), but must then contrast that with the care needed if that person did not receive the device. Examples of this “usual care” could include care by others in the home or in a continuous care setting, as well as healthcare costs that might result from that vision loss, such as medical care and hospital stays as a result of falling. All of these factors must be considered, along with the initial costs, to give a more realistic long-term cost-benefit analysis.
This article addresses that type of cost analysis for the Argus II using a hypothetical cohort of patients with RP (assuming improved sight, function, and health) and comparing this cohort with patients with RP who did not have the benefit of the device and were functioning “as usual.” Although the cost per patient was calculated in both US dollars and euros, the study was specifically conducted to “assess the cost-effectiveness of Argus II compared to usual care for the treatment of RP in Eurozone countries.”
After factoring in the many positive variables the authors believed were affected by the improvement in visual acuity due to the Argus II, and assuming all of the expectations that these calculations were based on were accurate, the authors concluded that this prosthetic device is, indeed, cost-effective. However, it will be important to conduct more research to further validate this model (with all of its assumptions) to more firmly establish the cost-effectiveness of this unique device.