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Journal of Ophthalmology
Volume 2009 (2009), Article ID 540431, 9 pages
Clinical Study

Joint Assessment of Intended and Unintended Effects of Medications: An Example Using Vascular Endothelial Growth Factor Inhibitors for Neovascular Age-Related Macular Degeneration

1Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada B3H 1V7
2Epidemiology, Oxford Outcomes Ltd., Vancouver, Canada V6B 1P1
3Section of Public Health and Health Policy, University of Glasgow, Glasgow G12 8RZ, UK
4Outcomes Research, Pfizer, La Jolla, CA 92121, USA
5Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD 21287, USA

Received 3 March 2009; Revised 31 July 2009; Accepted 2 December 2009

Academic Editor: Jie Jin Wang

Copyright © 2009 Adrian R. Levy et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. To estimate the net health benefits of pegaptanib and ranibizumab by considering the impact of visual acuity and unintended effects (cardiovascular and hemorrhagic events) on quality-of-life among persons with neovascular age-related macular degeneration. Methods. We designed a probabilistic decision-analytic model using published data. It employed 17 visual health states and three for unintended effects. We calculated incremental net health benefits by subtracting the harms of each medication from the benefit using the quality-adjusted life year (QALY). Results. In a hypothetical cohort of 1,000 75-year olds with new-onset bilateral age-related macular degeneration followed for ten years, the mean QALYs per patient is 3.7 for usual care, 4.2 for pegaptanib, and 4.3 for ranibizumab. Net benefits decline with increasing baseline rates of unintended effects. Interpretation. Net health benefits present a quantitative, potentially useful tool to assist patients and ophthalmologists in balancing the benefits and harms of interventions for age-related macular degeneration.