The Value of Persistence in Neovascular Age-Related Macular Degeneration
Author(s)
Christian Bührer, PhD1, Oliver Cox, PhD2, Philippe Margaron, PhD3.
1Evidence Lead, Roche, Basel, Switzerland, 2Roche, Basel, Switzerland, 3F. Hoffmann-La Roche Ltd, Basel, Switzerland.
1Evidence Lead, Roche, Basel, Switzerland, 2Roche, Basel, Switzerland, 3F. Hoffmann-La Roche Ltd, Basel, Switzerland.
OBJECTIVES: To demonstrate the critical importance of continuous treatment for patients with neovascular Age-related Macular Degeneration (nAMD) to preserve vision and improve quality of life, while also exploring the role of disease recurrence.
METHODS: Untreated nAMD progresses to severe vision loss and potential blindness, representing its natural history. Effective and appropriately administered therapies, such as faricimab in the TENAYA and LUCERNE studies, yield substantial and sustainable vision improvements. This analysis examines the link between treatment discontinuation and disease recurrence, leading to subsequent vision decline. Consequently, greater persistence to treatment enhances patient quality of life. Scenario analysis further considers the impact of bilateral vs. unilateral disease, baseline visual acuity and that some patients may not experience immediate disease recurrence.
RESULTS: In the base case, patients with bilateral disease and medium baseline visual acuity who stopped treatment within the first year were projected to lose more than one life year without visual impairment compared to continuous treatment until death. Consequently, this group also had a loss of more than two quality-adjusted life years (QALYs). Notably, even stopping treatment after four years still resulted in a loss of almost one QALY.
Scenario analysis indicates that while patients with unilateral disease can depend on their healthy eye's vision, early discontinuation of treatment is projected to result in a loss of about half a QALY. Varying baseline visual acuity did not significantly alter the base case results. Modeling delayed disease recurrence, which some patients might experience, predictably lessened the impact. However, discontinuing treatment within the first year was linked to a substantial loss of approximately 1.5 QALYs.
CONCLUSIONS: Persistence with effective treatment is paramount for patients with nAMD. Discontinuation of therapy carries a high risk of disease recurrence and vision deterioration, underscoring that in nAMD, persistence equals vision and preservation of quality of life.
METHODS: Untreated nAMD progresses to severe vision loss and potential blindness, representing its natural history. Effective and appropriately administered therapies, such as faricimab in the TENAYA and LUCERNE studies, yield substantial and sustainable vision improvements. This analysis examines the link between treatment discontinuation and disease recurrence, leading to subsequent vision decline. Consequently, greater persistence to treatment enhances patient quality of life. Scenario analysis further considers the impact of bilateral vs. unilateral disease, baseline visual acuity and that some patients may not experience immediate disease recurrence.
RESULTS: In the base case, patients with bilateral disease and medium baseline visual acuity who stopped treatment within the first year were projected to lose more than one life year without visual impairment compared to continuous treatment until death. Consequently, this group also had a loss of more than two quality-adjusted life years (QALYs). Notably, even stopping treatment after four years still resulted in a loss of almost one QALY.
Scenario analysis indicates that while patients with unilateral disease can depend on their healthy eye's vision, early discontinuation of treatment is projected to result in a loss of about half a QALY. Varying baseline visual acuity did not significantly alter the base case results. Modeling delayed disease recurrence, which some patients might experience, predictably lessened the impact. However, discontinuing treatment within the first year was linked to a substantial loss of approximately 1.5 QALYs.
CONCLUSIONS: Persistence with effective treatment is paramount for patients with nAMD. Discontinuation of therapy carries a high risk of disease recurrence and vision deterioration, underscoring that in nAMD, persistence equals vision and preservation of quality of life.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
CO249
Topic
Clinical Outcomes, Epidemiology & Public Health, Health Technology Assessment
Disease
Sensory System Disorders (Ear, Eye, Dental, Skin)