Objectives

For patients with polypoidal choroidal vasculopathy (PCV), intravitreal anti-vascular endothelial growth factor (anti-VEGF) combination therapy has been shown to be cost-saving relative to monotherapy in a clinical trial setting. However, whether this also applies to real-world settings is unclear. We aim to compare the real-world functional outcomes and cost-effectiveness of intravitreal anti-VEGF combination therapy relative to monotherapy, to investigate whether combination therapy is truly cost-saving.

Methods

We used a Markov model to simulate a hypothetical cohort of PCV patients treated at Singapore National Eye Centre. Model parameters were informed by coarsened exact matched estimates of a two-year retrospective study of patients who initiated treatment in 2015. Treatment options included intravitreal aflibercept, bevacizumab, or ranibizumab, as monotherapy or in combination with full-fluence verteporfin photodynamic therapy.

Results

The two-year logMAR letters gains were significant for combination therapy ( + 10.6, P = 0.006) but not monotherapy (−2.2, P = 0.459). Over 20 years, a PCV patient would cost the health system SGD 48,790 under monotherapy and SGD 61,020 under combination therapy. Quality-adjusted life-years (QALYs) were estimated to be 7.41 for monotherapy and 7.80 for combination therapy. The incremental cost-effectiveness ratio of combination therapy was SGD 31,460/QALY, which is less than the common willingness-to-pay threshold of per capita gross domestic product of Singapore (SGD 88,990/QALY). Sensitivity analysis showed that combination therapy remained incrementally cost-effective, but not cost-saving.

Conclusions

Our study shows that combination therapy is good value for money but is likely to increase costs when applied in real-world settings.

中文翻译：

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抗 VEGF 单药治疗和联合治疗治疗息肉状脉络膜血管病变的真实成本效益

 目标

对于息肉样脉络膜血管病变 (PCV) 患者，临床试验显示，玻璃体内注射抗血管内皮生长因子 (抗 VEGF) 联合治疗相对于单一治疗可节省成本。然而，这是否也适用于现实世界的环境尚不清楚。我们的目的是比较玻璃体内抗 VEGF 联合疗法相对于单一疗法的实际功能结果和成本效益，以研究联合疗法是否真正节省成本。

 方法

我们使用马尔可夫模型来模拟在新加坡国家眼科中心接受治疗的假设 PCV 患者队列。模型参数是通过对 2015 年开始治疗的患者进行的两年回顾性研究的粗略精确匹配估计得出的。治疗方案包括玻璃体内注射阿柏西普、贝伐珠单抗或雷珠单抗，作为单一疗法或与全通量维替泊芬光动力疗法组合。

 结果

联合治疗的两年 logMAR 字母增益显着（+ 10.6，磷= 0.006）但不是单一疗法（−2.2，磷= 0.459）。 20 多年来，一名 PCV 患者在单一治疗下将花费卫生系统 48,790 新元，在联合治疗下将花费 61,020 新元。单一疗法的质量调整生命年 (QALY) 估计为 7.41，联合疗法为 7.80。联合治疗的增量成本效益比为SGD 31,460/QALY，低于新加坡人均国内生产总值的常见支付意愿门槛（SGD 88,990/QALY）。敏感性分析表明，联合治疗仍然具有渐进的成本效益，但不节省成本。

 结论

我们的研究表明，联合疗法物有所值，但在现实环境中应用时可能会增加成本。