Base case | Low value | High value | Source | |
---|---|---|---|---|
Patients characteristics | ||||
Starting age – phakic | 63.80 | 56.24 | 71.36 | ICE-UK |
Starting age – pseudophakic | 68.50 | 66.90 | 70.10 | ICE-UK |
Proportion of males | 61.4% | 54.0% | 68.5% | ICE-UK |
Percentage of patients with DMO affecting both eyes at baseline | 76.6% | 70.0% | 82.6% | ICE-UK |
Percentage of FE with a cataract at baseline | 27.2% | 18.1% | 37.3% | ICE-UK |
Percentage of pseudophakic FE at baseline | 52.6% | 45.1% | 60.1% | ICE-UK |
Baseline distribution of BCVA levels | ICE-UK | |||
Probabilitiesb | ||||
Probability of developing DMO in the fellow eye, per cyclea | 5.4% | 2.4% | 9.7% | ICE-UK |
Probability of developing a cataract in the FE | 6.8% | 4.7% | 9.2% | FAME data, assumed to be the same as for laser photocoagulation [17] |
Probability of retreatment with FAc implant | 35.2% | 24.5% | 48.9% | Based on FAME data on ≥15 letter improvement in BCVA [17] |
Probability of retreatment with dexamethasone | 66.7% | 48.2% | 82.8% | Mastropasqua et al., 2015 [37] |
Probability of receiving study treatment in the FE | 30.4% | 22.2% | 39.1% | ICE-UK |
Probability of cataract surgery – change of intercept used within the logit model | Logit model on FAME data depending on the treatment phase and BCVA level | |||
Mortality | ||||
Relative mortality risk (diabetes) | 1.95 | 1.64 | 2.33 | Preis et al. – 2009 [38] |
Relative mortality risk (DMO) | 1.23 | 1.16 | 1.31 | Christ et al. – 2008 [39], Ranibizumab Technology Appraisal Guidance 2013 Section 13.4, page 13. [40] |
Transition probabilities | ||||
Transition Matrices between different BCVA levels for FAc implant and laser photocoagulationc | Multinomial logistic model applied to patient-level data from the ICE-UK study for pseudophakic patients and the full study population. | |||
Odds -ratio of BCVA improvement for dexamethasone vs. FAc implantb | 0.90 | 0.60 | 1.43 | Calibration method, based on the NMA results for mean change in BCVA letter score from baseline to 24 months for pseudophakic population with chronic DMO |
Odds-ratio of BCVA improvement for anti-VEGFs vs. laser photocoagulationb | 2.36 | 2.15 | 2.60 | |
Probability of worsening to lower BCVA level during the end-of-life phaseb | 3.5% | 2.3% | 5.0% | NICE ERG report for aflibercept [25] |
Usual care treatment mix | ||||
Laser photocoagulation | 28.3% | 20.3% | 38.2% | ICE-UK, low and high value defined for laser, for the rest of treatments calculated proportionally to the base case scenario |
Ranibizumab 0.5 mg/injection | 62.6% | 69.6% | 53.9% | |
Bevacizumab 1.25 mg/injection | 9.1% | 10.1% | 7.8% | |
Aflibercept 2 mg/injection | 0% | 0% | 0% | |
Number of drug administrations per treatment regimen | ||||
FAc 0.2 μg/day implant [per 3 years] | 1 | – | – | FAc 0.2 μg/day implant SPC [9] |
Laser photocoagulation [per year] | 0.98 | 0.74 | 1.23 | NICE ERG report of aflibercept [25] |
Usual Care [per year] | 1.68 | 1.31 | 2.05 | ICE-UK |
Dexamethasone [per 6 months] | 1 | – | – | Dexamethasone SPC, conservative assumption [8] |
Drug costs | ||||
FAc 0.2 μg/day implant | £5500.00 | – | – | Alimera Science |
Ranibizumab | £551.00 | £330.60 | – | DM + D |
Bevacizumab | £242.66 | £145.60 | – | BNF (January 2017) |
Aflibercept | £816.00 | £489.60 | – | BNF (January 2017) |
Dexamethasone | £870.00 | £522.00 | – | BNF (January 2017) |
Health state utilities | ||||
Utilities depended on the BCVA levels | According to the study by Czoski-Murray et al. 2009 [24], worse BCVA level was related to lower health state utility. Both eyes were considered when determining utility depending on visual acuity: values varied from 0.8559 for both eyes with the highest possible visual acuity, to 0.2634 for both blind eyes. Baseline utility in the model was estimated to be 0.63 and 0.66 in the pseudophakic and phakic population, respectively. | |||
Utility decrements | ||||
Retinal detachment repair | 0.130 | 0.079 | 0.181 | Evidence Review Group report for aflibercept submission (p. 82) [25] |
Vitreous haemorrhage | 0.020 | 0.012 | 0.028 | |
Disutility for anxiety associated with injections applied during treatment with anti-VEGFs | 0.071 | 0.043 | 0.099 | UK population norms EQ-5D [41] |
Percentage of patients with anxiety while on treatment with anti-VEGFs | 0.173 | 0.133 | 0.218 | Senra et.al. 2017 [26] |