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Published in: BMC Ophthalmology 1/2014

Open Access 01-12-2014 | Research article

The cost-effectiveness of the Argus II retinal prosthesis in Retinitis Pigmentosa patients

Authors: Anil Vaidya, Elio Borgonovi, Rod S Taylor, José-Alain Sahel, Stanislao Rizzo, Paulo Eduardo Stanga, Amit Kukreja, Peter Walter

Published in: BMC Ophthalmology | Issue 1/2014

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Abstract

Background

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.
Appendix
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Literature
1.
2.
go back to reference Hartong DT, Berson EL, Dryja TP: Retinitis pigmentosa. Lancet. 2006, 368 (9549): 1795-1809. 10.1016/S0140-6736(06)69740-7.CrossRefPubMed Hartong DT, Berson EL, Dryja TP: Retinitis pigmentosa. Lancet. 2006, 368 (9549): 1795-1809. 10.1016/S0140-6736(06)69740-7.CrossRefPubMed
3.
go back to reference Taylor HR: LXIII Edward Jackson memorial lecture: eye care: dollars and sense. Am J Ophthalmol. 2007, 143 (1): 1-8. 10.1016/j.ajo.2006.10.003. e1CrossRefPubMed Taylor HR: LXIII Edward Jackson memorial lecture: eye care: dollars and sense. Am J Ophthalmol. 2007, 143 (1): 1-8. 10.1016/j.ajo.2006.10.003. e1CrossRefPubMed
4.
go back to reference Hahm B-J, Shin Y-W, Shim E-J, Jeon HJ, Seo J-M, Chung H, Yu HG: Depression and the vision-related quality of life in patients with retinitis pigmentosa. Br J Ophthalmol. 2008, 92 (5): 650-654. 10.1136/bjo.2007.127092.CrossRefPubMed Hahm B-J, Shin Y-W, Shim E-J, Jeon HJ, Seo J-M, Chung H, Yu HG: Depression and the vision-related quality of life in patients with retinitis pigmentosa. Br J Ophthalmol. 2008, 92 (5): 650-654. 10.1136/bjo.2007.127092.CrossRefPubMed
5.
go back to reference Winkler MS, Krieger GR, Divall MJ, Cisse G, Wielga M, Singer BH, Tanner M, Utzinger J: Untapped potential of health impact assessment. Bull World Health Organ. 2013, 91 (4): 298-305. 10.2471/BLT.12.112318.CrossRefPubMedPubMedCentral Winkler MS, Krieger GR, Divall MJ, Cisse G, Wielga M, Singer BH, Tanner M, Utzinger J: Untapped potential of health impact assessment. Bull World Health Organ. 2013, 91 (4): 298-305. 10.2471/BLT.12.112318.CrossRefPubMedPubMedCentral
7.
go back to reference Salzmann J, Linderholm OP, Guyomard JL, Paques M, Simonutti M, Lecchi M, Sommerhalder J, Dubus E, Pelizzone M, Bertrand D, Sahel J, Renaud P, Safran AB, Picaud S: Subretinal electrode implantation in the P23H rat for chronic stimulations. Br J Ophthalmol. 2006, 90 (9): 1183-1187. 10.1136/bjo.2005.089110.CrossRefPubMedPubMedCentral Salzmann J, Linderholm OP, Guyomard JL, Paques M, Simonutti M, Lecchi M, Sommerhalder J, Dubus E, Pelizzone M, Bertrand D, Sahel J, Renaud P, Safran AB, Picaud S: Subretinal electrode implantation in the P23H rat for chronic stimulations. Br J Ophthalmol. 2006, 90 (9): 1183-1187. 10.1136/bjo.2005.089110.CrossRefPubMedPubMedCentral
8.
go back to reference Humayun MS, Weiland JD, Fujii GY, Greenberg R, Williamson R, Little J, Mech B, Cimmarusti V, Van Boemel G, Dagnelie G, de Juan E: Visual perception in a blind subject with a chronic microelectronic retinal prosthesis. Vision Res. 2003, 43 (24): 2573-2581. 10.1016/S0042-6989(03)00457-7.CrossRefPubMed Humayun MS, Weiland JD, Fujii GY, Greenberg R, Williamson R, Little J, Mech B, Cimmarusti V, Van Boemel G, Dagnelie G, de Juan E: Visual perception in a blind subject with a chronic microelectronic retinal prosthesis. Vision Res. 2003, 43 (24): 2573-2581. 10.1016/S0042-6989(03)00457-7.CrossRefPubMed
9.
go back to reference Humayun MS, Dorn JD, da Cruz L, Dagnelie G, Sahel JA, Stanga PE, Cideciyan AV, Duncan JL, Eliott D, Filley E, Ho AC, Santos A, Safran AB, Arditi A, Del Priore LV, Greenberg RJ, Argus IISG, Ho AC, Santos A, Safran AB, Arditi A, Del Priore LV, Greenberg RJ, Argus IISG: Interim results from the international trial of Second Sight’s visual prosthesis. Ophthalmology. 2012, 119 (4): 779-788. 10.1016/j.ophtha.2011.09.028.CrossRefPubMedPubMedCentral Humayun MS, Dorn JD, da Cruz L, Dagnelie G, Sahel JA, Stanga PE, Cideciyan AV, Duncan JL, Eliott D, Filley E, Ho AC, Santos A, Safran AB, Arditi A, Del Priore LV, Greenberg RJ, Argus IISG, Ho AC, Santos A, Safran AB, Arditi A, Del Priore LV, Greenberg RJ, Argus IISG: Interim results from the international trial of Second Sight’s visual prosthesis. Ophthalmology. 2012, 119 (4): 779-788. 10.1016/j.ophtha.2011.09.028.CrossRefPubMedPubMedCentral
10.
go back to reference Weinstein MC, O’Brien B, Hornberger J, Jackson J, Johannesson M, McCabe C, Luce BR: Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR task force on good research practices–modeling studies. Value Health. 2003, 6 (1): 9-17. 10.1046/j.1524-4733.2003.00234.x.CrossRefPubMed Weinstein MC, O’Brien B, Hornberger J, Jackson J, Johannesson M, McCabe C, Luce BR: Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR task force on good research practices–modeling studies. Value Health. 2003, 6 (1): 9-17. 10.1046/j.1524-4733.2003.00234.x.CrossRefPubMed
11.
go back to reference Tsujikawa M, Wada Y, Sukegawa M, Sawa M, Gomi F, Nishida K, Tano Y: Age at onset curves of retinitis pigmentosa. Arch Ophthalmol. 2008, 126 (3): 337-340. 10.1001/archopht.126.3.337.CrossRefPubMed Tsujikawa M, Wada Y, Sukegawa M, Sawa M, Gomi F, Nishida K, Tano Y: Age at onset curves of retinitis pigmentosa. Arch Ophthalmol. 2008, 126 (3): 337-340. 10.1001/archopht.126.3.337.CrossRefPubMed
12.
go back to reference Birch DG, Anderson JL, Fish GE: Yearly rates of rod and cone functional loss in retinitis pigmentosa and cone-rod dystrophy. Ophthalmology. 1999, 106 (2): 258-268. 10.1016/S0161-6420(99)90064-7.CrossRefPubMed Birch DG, Anderson JL, Fish GE: Yearly rates of rod and cone functional loss in retinitis pigmentosa and cone-rod dystrophy. Ophthalmology. 1999, 106 (2): 258-268. 10.1016/S0161-6420(99)90064-7.CrossRefPubMed
13.
go back to reference Jessy D, Dorn DG, Gislin D, Robert J, Greenberg, FLORA Working Group, Argus II Study Group: Functional vision and quality of life of Argus® II Retinal Prosthesis System users as measured by the Functional Low-vision Observer Rated Assessment (FLORA). The Assciation for Research in Vision and Ophthalmology (AVRO). 2012, Florida: Fort Lauderdale Jessy D, Dorn DG, Gislin D, Robert J, Greenberg, FLORA Working Group, Argus II Study Group: Functional vision and quality of life of Argus® II Retinal Prosthesis System users as measured by the Functional Low-vision Observer Rated Assessment (FLORA). The Assciation for Research in Vision and Ophthalmology (AVRO). 2012, Florida: Fort Lauderdale
14.
go back to reference Frick KD, Roebuck MC, Feldstein JI, McCarty CA, Grover LL: Health services utilization and cost of retinitis pigmentosa. Arch Ophthalmol. 2012, 130 (5): 629-634.CrossRefPubMed Frick KD, Roebuck MC, Feldstein JI, McCarty CA, Grover LL: Health services utilization and cost of retinitis pigmentosa. Arch Ophthalmol. 2012, 130 (5): 629-634.CrossRefPubMed
16.
go back to reference Javitt JC, Zhou Z, Willke RJ: Association between vision loss and higher medical care costs in medicare beneficiaries costs are greater for those with progressive vision loss. Ophthalmology. 2007, 114 (2): 238-245. 10.1016/j.ophtha.2006.07.054.CrossRefPubMed Javitt JC, Zhou Z, Willke RJ: Association between vision loss and higher medical care costs in medicare beneficiaries costs are greater for those with progressive vision loss. Ophthalmology. 2007, 114 (2): 238-245. 10.1016/j.ophtha.2006.07.054.CrossRefPubMed
17.
go back to reference Hernandez-Pastor LJ, Ortega A, Garcia-Layana A, Giraldez J: Cost-effectiveness of ranibizumab compared with pegaptanib in neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol. 2010, 248 (4): 467-476. 10.1007/s00417-009-1156-9.CrossRefPubMed Hernandez-Pastor LJ, Ortega A, Garcia-Layana A, Giraldez J: Cost-effectiveness of ranibizumab compared with pegaptanib in neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol. 2010, 248 (4): 467-476. 10.1007/s00417-009-1156-9.CrossRefPubMed
18.
go back to reference Brown MM, Brown GC, Sharma S, Landy J: Health care economic analyses and value-based medicine. Surv Ophthalmol. 2003, 48 (2): 204-223. 10.1016/S0039-6257(02)00457-5.CrossRefPubMed Brown MM, Brown GC, Sharma S, Landy J: Health care economic analyses and value-based medicine. Surv Ophthalmol. 2003, 48 (2): 204-223. 10.1016/S0039-6257(02)00457-5.CrossRefPubMed
19.
go back to reference Schiffman RM, Walt JG, Jacobsen G, Doyle JJ, Lebovics G, Sumner W: Utility assessment among patients with dry eye disease. Ophthalmology. 2003, 110 (7): 1412-1419. 10.1016/S0161-6420(03)00462-7.CrossRefPubMed Schiffman RM, Walt JG, Jacobsen G, Doyle JJ, Lebovics G, Sumner W: Utility assessment among patients with dry eye disease. Ophthalmology. 2003, 110 (7): 1412-1419. 10.1016/S0161-6420(03)00462-7.CrossRefPubMed
21.
go back to reference Stinnett AA, Mullahy J: Net health benefits: a new framework for the analysis of uncertainty in cost-effectiveness analysis. Med Decis Making. 1998, 18 (2 Suppl): S68-S80.CrossRefPubMed Stinnett AA, Mullahy J: Net health benefits: a new framework for the analysis of uncertainty in cost-effectiveness analysis. Med Decis Making. 1998, 18 (2 Suppl): S68-S80.CrossRefPubMed
22.
go back to reference Fenwick E, Byford S: A guide to cost-effectiveness acceptability curves. Br J Psychiatry. 2005, 187: 106-108. 10.1192/bjp.187.2.106.CrossRefPubMed Fenwick E, Byford S: A guide to cost-effectiveness acceptability curves. Br J Psychiatry. 2005, 187: 106-108. 10.1192/bjp.187.2.106.CrossRefPubMed
23.
go back to reference Laupacis A, Feeny D, Detsky AS, Tugwell PX: How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ. 1992, 146 (4): 473-481.PubMedPubMedCentral Laupacis A, Feeny D, Detsky AS, Tugwell PX: How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ. 1992, 146 (4): 473-481.PubMedPubMedCentral
24.
go back to reference Grosse SD: Assessing cost-effectiveness in healthcare: history of the $50,000 per QALY threshold. Expert Rev Pharmacoecon Outcomes Res. 2008, 8 (2): 165-178. 10.1586/14737167.8.2.165.CrossRefPubMed Grosse SD: Assessing cost-effectiveness in healthcare: history of the $50,000 per QALY threshold. Expert Rev Pharmacoecon Outcomes Res. 2008, 8 (2): 165-178. 10.1586/14737167.8.2.165.CrossRefPubMed
26.
28.
go back to reference Simoens S: Health economic assessment: cost-effectiveness thresholds and other decision criteria. Int J Environ Res Public Health. 2010, 7 (4): 1835-1840. 10.3390/ijerph7041835.CrossRefPubMedPubMedCentral Simoens S: Health economic assessment: cost-effectiveness thresholds and other decision criteria. Int J Environ Res Public Health. 2010, 7 (4): 1835-1840. 10.3390/ijerph7041835.CrossRefPubMedPubMedCentral
29.
go back to reference Rosenkotter N, Vondeling H, Blancquaert I, Mekel OC, Kristensen FB, Brand A: The contribution of health technology assessment, health needs assessment, and health impact assessment to the assessment and translation of technologies in the field of public health genomics. Public Health Genomics. 2011, 14 (1): 43-52. 10.1159/000318317.CrossRefPubMed Rosenkotter N, Vondeling H, Blancquaert I, Mekel OC, Kristensen FB, Brand A: The contribution of health technology assessment, health needs assessment, and health impact assessment to the assessment and translation of technologies in the field of public health genomics. Public Health Genomics. 2011, 14 (1): 43-52. 10.1159/000318317.CrossRefPubMed
30.
go back to reference Drummond M, Evans B, LeLorier J, Karakiewicz P, Martin D, Tugwell P, MacLeod S: Evidence and values: requirements for public reimbursement of drugs for rare diseases–a case study in oncology. Can J Clin Pharmacol. 2009, 16 (2): e273-e281. discussion e282-274PubMed Drummond M, Evans B, LeLorier J, Karakiewicz P, Martin D, Tugwell P, MacLeod S: Evidence and values: requirements for public reimbursement of drugs for rare diseases–a case study in oncology. Can J Clin Pharmacol. 2009, 16 (2): e273-e281. discussion e282-274PubMed
Metadata
Title
The cost-effectiveness of the Argus II retinal prosthesis in Retinitis Pigmentosa patients
Authors
Anil Vaidya
Elio Borgonovi
Rod S Taylor
José-Alain Sahel
Stanislao Rizzo
Paulo Eduardo Stanga
Amit Kukreja
Peter Walter
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Ophthalmology / Issue 1/2014
Electronic ISSN: 1471-2415
DOI
https://doi.org/10.1186/1471-2415-14-49

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