Cost-Effectiveness Analysis of Fluocinolone Acetonide Intravitreal (FAI) Implant for Chronic Noninfectious Uveitis Affecting the Posterior Segment of the Eye (NIU-PS) in China

Abstract

Introduction: Chronic non-infectious uveitis affecting the posterior segment (NIU-PS), which can be recurrent and persistent for numerous years, mainly affects people of working age and significantly increases the risk of visual impairment. This study aimed to investigate the cost-effectiveness of fluocinolone acetonide intravitreal (FAI) implant in the treatment of patients with chronic NIU-PS from the Chinese healthcare perspective.

Methods: A Markov model with a 2-week cycle was constructed from the perspective of the Chinese healthcare system over a lifetime time horizon. The model consists of four health states: on-treatment, treatment failure, blindness, and death. The outcomes for effectiveness were based on the Chinese real-world study (RWS). Utilities and mortality rates were derived from published literature and standard sources. Costs were determined from the MENET website, prices of medical service items at local providers, published literature, and expert surveys. Outcomes were measured in quality-adjusted life years (QALYs). Sensitivity analyses were performed to account for the impact of uncertainty.

Results: It was estimated that in the base case, the FAI implant provided 0.43 incremental QALYs compared with the limited current practice (LCP) at an additional cost of $7503.72 (¥50,575.05), resulting in an incremental cost-effectiveness ratio (ICER) of $17,373.49 (¥117,097.33) per QALY gained. Parameters related to utility emerged as the primary influencers on the outcomes. In probabilistic sensitivity analysis (PSA), considering the willingness-to-pay (WTP) threshold of $19,072 (¥128,547) and $38,145 (¥257,094), the FAI implant had 67.70% and 99.50% probability of being cost-effective, respectively. As demonstrated in the scenario analysis, if the FAI implant aligns its price reduction with the average rate from the 2023 negotiation of the National Reimbursement Drug List (NRDL), it would result in lower costs and represent an absolute advantage.

Conclusions: The FAI implant, which can effectively reduce the recurrence rate and maintain the incremental costs within the WTP limit, is likely to be cost-effective in treating chronic NIU-PS in China.

Keywords: Cost-effectiveness analysis; Fluocinolone acetonide intravitreal implant; Incremental cost-effectiveness ratios; Non-infectious uveitis; Real-world study.

Fig. 1

Markov model structure. The structure included four health states (1) on-treatment, (2) treatment failure, (3) blindness, and (4) death

Fig. 2

Tornado diagram for DSA. The tornado diagram showcased the ten most influential parameters in descending order of ICER sensitivity. FAI fluocinolone acetonide intravitreal, LCP limited current practice, DSA deterministic sensitivity analysis, ICER incremental cost-effectiveness ratio

Fig. 3

Cost-effectiveness scatters plot. The scatter points represent the 1000 pairs of incremental cost and incremental QALY. The lines representing the thresholds of cost-effective (WTP of $38,145, three times GDP per capita) and very cost-effective (WTP of $12,715, one time GDP per capita). PSA probabilistic sensitivity analysis, GDP gross domestic product, QALY quality-adjusted life year, WTP willingness-to-pay

Fig. 4

Cost-effectiveness acceptability curve. The curves showing the probability (y-axis) that the strategy is cost-effective at different WTP thresholds (x-axis). FAI fluocinolone acetonide intravitreal, LCP limited current practice, WTP willingness-to-pay