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Qiu T, Aballéa S, Pochopień M, Toumi M, Dussart C, Yan D. A systematic review on the appropriate discounting rates for the economic evaluation of gene therapies: whether a specific approach is justified to tackle the challenges? Int J Technol Assess Health Care 2024; 40:e23. [PMID: 38725378 DOI: 10.1017/s0266462324000096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
OBJECTIVES Discounting the cost and effect for health intervention is a controversial topic over the last two decades. In particular, the cost-effectiveness of gene therapies is especially sensitive to the discount rate because of the substantial delay between the upfront cost incurred and long-lasing clinical benefits received. This study aims to investigate the influence of employing alternative discount rates on the incremental cost-effectiveness ratio (ICER) of gene therapies. METHODS A systematic review was conducted to include health economic evaluations of gene therapies that were published until April 2023. RESULTS Sensitivity or scenario analysis indicated that discount rate represented one of the most influential factors for the ICERs of gene therapies. Discount rate for cost and benefit was positively correlated with the cost-effectiveness of gene therapies, that is, a lower discount rate significantly improves the ICERs. The alternative discount rate employed in some cases could be powerful to alter the conclusion on whether gene therapies are cost-effective and acceptable for reimbursement. CONCLUSIONS Although discount rate will have substantial influence on the ICERs of gene therapies, there lacks solid evidence to justify a different discounting rule for gene therapies. However, it is proposed that the discount rate in the reference case should be updated to reflect the real-time preference, which in turn will affect the ICERs and reimbursement of gene therapies more profoundly than conventional therapies.
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Affiliation(s)
- Tingting Qiu
- Beijing Institute of Clinical Pharmacy, Beijing Friendship Hospital of Capital Medical University, Beijing, China
- Public Health Department, Aix-Marseille University, Marseille, France
| | - Samuel Aballéa
- Public Health Department, Aix-Marseille University, Marseille, France
| | - Michal Pochopień
- Public Health Department, Aix-Marseille University, Marseille, France
| | - Mondher Toumi
- Public Health Department, Aix-Marseille University, Marseille, France
| | - Claude Dussart
- Faculté de Pharmacie, Université Claude Bernard Lyon 1, Lyon, France
| | - Dan Yan
- Beijing Institute of Clinical Pharmacy, Beijing Friendship Hospital of Capital Medical University, Beijing, China
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Abuloha S, Niu S, Adirika D, Harvey BP, Svensson M. A Review of the Cost-Effectiveness Evidence for FDA-Approved Cell and Gene Therapies. Hum Gene Ther 2024. [PMID: 38526393 DOI: 10.1089/hum.2023.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Cell and gene therapy (CGT) innovations have provided several significant breakthroughs in recent years. However, CGTs often come with a high upfront cost, raising questions about patient access, affordability, and long-term value. This study reviewed cost-effectiveness analysis (CEA) studies that have attempted to assess the long-term value of Food and Drug Administration (FDA)-approved CGTs. Two reviewers independently searched the Tufts Medical Center CEA Registry to identify all studies for FDA-approved CGTs, per January 2023. A data extraction template was used to summarize the evidence in terms of the incremental cost-effectiveness ratio expressed as the cost per quality-adjusted life year (QALY) and essential modeling assumptions, combined with a template to extract the adherence to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. The review identified 26 CEA studies for seven CGTs. Around half of the base-case cost-effectiveness results indicated that the cost per QALY was below $100,000-$150,000, often used as a threshold for reasonable cost-effectiveness in the United States. However, the results varied substantially across studies for the same treatment, ranging from being considered very cost-effective to far from cost-effective. Most models were based on data from single-arm trials with relatively short follow-ups, and different long-term extrapolations between studies caused large differences in the modeled cost-effectiveness results. In sum, this review showed that, despite the high upfront costs, many CGTs have cost-effectiveness evidence that can support long-term value. Nonetheless, substantial uncertainty regarding long-term value exists because so much of the modeling results are driven by uncertain extrapolations beyond the clinical trial data.
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Affiliation(s)
- Sumaya Abuloha
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Department of Clinical Pharmacy and Pharmacy Practice, College of Pharmacy, Yarmouk University, Irbid, Jordan
| | - Shu Niu
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Darlene Adirika
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Benjamin P Harvey
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Svensson
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
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Teoh LJ, Kellett S, Patel DE, Cortina-Borja M, Solebo AL, Rahi JS. Evaluating the Quantity and Quality of Health Economic Literature in Blinding Childhood Disorders: A Systematic Literature Review. PHARMACOECONOMICS 2024; 42:275-299. [PMID: 37971639 PMCID: PMC7615631 DOI: 10.1007/s40273-023-01311-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Evidence on the socioeconomic burden associated with childhood visual impairment, severe visual impairment and blindness (VI/SVI/BL) is needed to inform economic evaluations of existing and emerging interventions aimed at protecting or improving vision. This study aimed to evaluate the quantity and quality of literature on resource use and/or costs associated with childhood VI/SVI/BL disorders. METHODS PubMed, Web of Science (Ovid), the National Health Service (NHS) Economic Evaluation Database and grey literature were searched in November 2020. The PubMed search was rerun in February 2022. Original articles reporting unique estimates of resource use or cost data on conditions resulting in bilateral VI/SVI/BL were eligible for data extraction. Quality assessment (QA) was undertaken using the Drummond checklist adapted for cost-of-illness (COI) studies. RESULTS We identified 31 eligible articles, 27 from the peer-reviewed literature and four from the grey literature. Two reported on resource use, and 29 reported on costs. Cerebral visual impairment and optic nerve disorders were not examined in any included studies, whereas retinopathy of prematurity was the most frequently examined condition. The quality of studies varied, with economic evaluations having higher mean QA scores (82%) compared to COI studies (77%). Deficiencies in reporting were seen, particularly in the clinical definitions of conditions in economic evaluations and a lack of discounting and sensitivity analyses in COI studies. CONCLUSIONS There is sparse literature on resource use or costs associated with childhood visual impairment disorders. The first step in addressing this important evidence gap is to ensure core visual impairment outcomes are measured in future randomised control trials of interventions as well as cohort studies and are reported as a discrete health outcome.
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Affiliation(s)
- Lucinda J Teoh
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK.
- Ulverscroft Vision Research Group, UCL Great Ormond Street Institute of Child Health, University College London, London, UK.
| | - Salomey Kellett
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Ulverscroft Vision Research Group, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Dipesh E Patel
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Ulverscroft Vision Research Group, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Moorfields NIHR Biomedical Research Centre, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Ulverscroft Vision Research Group, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Ameenat Lola Solebo
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Great Ormond Street Hospital for Children NHS Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- Ulverscroft Vision Research Group, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Moorfields NIHR Biomedical Research Centre, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - Jugnoo S Rahi
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Great Ormond Street Hospital for Children NHS Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- Ulverscroft Vision Research Group, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Moorfields NIHR Biomedical Research Centre, London, UK
- UCL Institute of Ophthalmology, London, UK
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McGuinness MB, Ayton LN, Schofield D, Britten-Jones AC, Chen FK, Grigg JR, Qi Z, Kraindler J, Shrestha R, Mack HG. EQ-5D-5L health utility scores in Australian adults with inherited retinal diseases: A cross-sectional survey. Acta Ophthalmol 2024. [PMID: 38226448 DOI: 10.1111/aos.16634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/21/2023] [Accepted: 01/04/2024] [Indexed: 01/17/2024]
Abstract
PURPOSE Economic evaluations of interventions for ocular disease require utility scores that accurately represent quality of life in the target population. This study aimed to describe the distribution of EQ-5D-5L utility values among Australian adults with symptomatic inherited retinal diseases (IRDs) and to assess the relationship between these scores and vision-related quality of life. METHODS A survey was administered predominantly online in 2021. Participants completed the EQ-5D-5L general health utility instrument, the EQ vertical visual analogue scale (EQ-VAS) and the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25). Self-reported IRD diagnoses were classified as being associated with central or widespread retinal involvement. RESULTS Responses from 647 participants aged 18-93 years were included, 50.1% were men and 77.6% had an IRD associated with widespread retinal involvement. The majority reported no problems with self-care and no pain/discomfort but did report anxiety/depression and problems with work, study, housework, or family/leisure activities. Most people with widespread involvement reported problems with mobility. Median EQ-5D-5L utility was 0.88 and 0.91 among people with widespread and central involvement, respectively (age and sex-adjusted p = 0.029); and median EQ-VAS was 75 and 80, respectively (adjusted p = 0.003). A moderate curvilinear correlation was observed between EQ-5D-5L and NEI-VFQ-25 composite score (Spearman's ρ 0.69), but not all people with poor vision-related quality of life had low EQ-5D-5L utility values. CONCLUSIONS EQ-5D-5L health utility values are correlated with vision-related quality of life among adults with IRDs. However, the EQ-5D-5L may not be sensitive to the full impact of vision impairment on quality of life.
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Affiliation(s)
- Myra B McGuinness
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Lauren N Ayton
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah Schofield
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, Sydney, New South Wales, Australia
| | - Alexis Ceecee Britten-Jones
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Fred K Chen
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Ophthalmology and Visual Sciences (incorporating Lions Eye Institute), The University of Western Australia, Perth, Western Australia, Australia
- Department of Ophthalmology, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - John R Grigg
- Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
- Eye Genetics Research Unit, Sydney Children's Hospitals Network, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Ziyi Qi
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Joshua Kraindler
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, Sydney, New South Wales, Australia
| | - Rupendra Shrestha
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, Sydney, New South Wales, Australia
| | - Heather G Mack
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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Schofield D, Kraindler J, Tan O, Shrestha RN, West S, Hart N, Tan L, Ma A, Grigg JR, Jamieson RV. The health care and societal costs of inherited retinal diseases in Australia: a microsimulation modelling study. Med J Aust 2023; 219:70-76. [PMID: 37301731 PMCID: PMC10952471 DOI: 10.5694/mja2.51997] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 05/03/2023] [Accepted: 05/09/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To estimate the health care and societal costs of inherited retinal diseases (IRDs) in Australia. DESIGN, SETTING, PARTICIPANTS Microsimulation modelling study based on primary data - collected in interviews of people with IRDs who had ophthalmic or genetic consultations at the Children's Hospital at Westmead or the Save Sight Institute (both Sydney) during 1 January 2019 - 31 December 2020, and of their carers and spouses - and linked Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Schedule (PBS) data. MAIN OUTCOME MEASURES Annual and lifetime costs for people with IRDs and for their carers and spouses, grouped by payer (Australian government, state governments, individuals, private health insurance) and type (health care costs; societal costs: social support, National Disability Insurance Scheme (NDIS), income and taxation, costs associated with caring for family members with IRDs); estimated annual national cost of IRDs. RESULTS Ninety-four people (74 adults, 20 people under 18 years; 55 girls and women [59%]) and 30 carers completed study surveys (participation rate: adults, 66%; children, 66%; carers, 63%). Total estimated lifetime cost was $5.2 million per person with an IRD, of which 87% were societal and 13% health care costs. The three highest cost items were lost income for people with IRDs ($1.4 million), lost income for their carers and spouses ($1.1 million), and social spending by the Australian government (excluding NDIS expenses: $1.0 million). Annual costs were twice as high for people who were legally blind as for those with less impaired vision ($83 910 v $41 357 per person). The estimated total annual cost of IRDs in Australia was $781 million to $1.56 billion. CONCLUSION As the societal costs associated with IRDs are much larger than the health care costs, both contributors should be considered when assessing the cost-effectiveness of interventions for people with IRDs. The increasing loss of income across life reflects the impact of IRDs on employment and career opportunities.
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Affiliation(s)
- Deborah Schofield
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business SchoolMacquarie UniversitySydneyNSW
| | - Joshua Kraindler
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business SchoolMacquarie UniversitySydneyNSW
| | - Owen Tan
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business SchoolMacquarie UniversitySydneyNSW
| | - Rupendra N Shrestha
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business SchoolMacquarie UniversitySydneyNSW
| | - Sarah West
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business SchoolMacquarie UniversitySydneyNSW
| | - Natalie Hart
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business SchoolMacquarie UniversitySydneyNSW
| | - Liny Tan
- Children's Medical Research Institute, Sydney Children's Hospitals NetworkUniversity of SydneySydneyNSW
- Save Sight InstituteUniversity of SydneySydneyNSW
| | - Alan Ma
- Children's Medical Research Institute, Sydney Children's Hospitals NetworkUniversity of SydneySydneyNSW
- Save Sight InstituteUniversity of SydneySydneyNSW
- The University of SydneySydneyNSW
| | - John R Grigg
- Children's Medical Research Institute, Sydney Children's Hospitals NetworkUniversity of SydneySydneyNSW
- Save Sight InstituteUniversity of SydneySydneyNSW
- The University of SydneySydneyNSW
| | - Robyn V Jamieson
- Children's Medical Research Institute, Sydney Children's Hospitals NetworkUniversity of SydneySydneyNSW
- Save Sight InstituteUniversity of SydneySydneyNSW
- The University of SydneySydneyNSW
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Gavan SP, Wright SJ, Thistlethwaite F, Payne K. Capturing the Impact of Constraints on the Cost-Effectiveness of Cell and Gene Therapies: A Systematic Review. PHARMACOECONOMICS 2023; 41:675-692. [PMID: 36905571 DOI: 10.1007/s40273-022-01234-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Decision-makers need to resolve constraints on delivering cell and gene therapies to patients as these treatments move into routine care. This study aimed to investigate if, and how, constraints that affect the expected cost and health consequences of cell and gene therapies have been included in published examples of cost-effectiveness analyses (CEAs). METHOD A systematic review identified CEAs of cell and gene therapies. Studies were identified from previous systematic reviews and by searching Medline and Embase until 21 January 2022. Constraints described qualitatively were categorised by theme and summarised by a narrative synthesis. Constraints evaluated in quantitative scenario analyses were appraised by whether they changed the decision to recommend treatment. RESULTS Thirty-two CEAs of cell (n = 20) and gene therapies (n = 12) were included. Twenty-one studies described constraints qualitatively (70% cell therapy CEAs; 58% gene therapy CEAs). Qualitative constraints were categorised by four themes: single payment models; long-term affordability; delivery by providers; manufacturing capability. Thirteen studies assessed constraints quantitatively (60% cell therapy CEAs; 8% gene therapy CEAs). Two types of constraint were assessed quantitatively across four jurisdictions (USA, Canada, Singapore, The Netherlands): alternatives to single payment models (n = 9 scenario analyses); improving manufacturing (n = 12 scenario analyses). The impact on decision-making was determined by whether the estimated incremental cost-effectiveness ratios crossed a relevant cost-effectiveness threshold for each jurisdiction (outcome-based payment models: n = 25 threshold comparisons made, 28% decisions changed; improving manufacturing: n = 24 threshold comparisons made, 4% decisions changed). CONCLUSION The net health impact of constraints is vital evidence to help decision-makers scale up the delivery of cell and gene therapies as patient volume increases and more advanced therapy medicinal products are launched. CEAs will be essential to quantify how constraints affect the cost-effectiveness of care, prioritise constraints to be resolved, and establish the value of strategies to implement cell and gene therapies by accounting for their health opportunity cost.
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Affiliation(s)
- Sean P Gavan
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Stuart J Wright
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Fiona Thistlethwaite
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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Olry de Labry-Lima A, Ponce-Polo A, García-Mochón L, Ortega-Ortega M, Pérez-Troncoso D, Epstein D. Challenges for Economic Evaluations of Advanced Therapy Medicinal Products: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:138-150. [PMID: 36031480 DOI: 10.1016/j.jval.2022.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/20/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Advanced therapy medicinal products (ATMPs) are drugs for human use for the treatment of chronic, degenerative, or life-threatening diseases that are based on genes, tissues, or cells. This article aimed to identify and critically review published economic analyses of ATMPs. METHODS A systematic review of economic analyses of ATMPs was undertaken. Study characteristics, design, sources of data, resources and unit costs, modeling and extrapolation methods, study results, and sensitivity analyses were assessed. RESULTS A total of 46 economic analyses of ATMP (from 45 articles) were included; 4 were cell therapy medicinal products, 33 gene therapy medicinal products, and 9 tissue-engineered products. 30 therapies had commercial marketing approval; 39 studies were cost-utility analysis, 5 were cost-effectiveness analysis, and 2 were cost only studies. Four studies predicted that the ATMP offered a step change in the management of the condition and 10 studies estimated that the ATMP would offer a lower mean cost. CONCLUSIONS Comparison with historical controls, pooling of data, and use of techniques such as mixture cure fraction models should be used cautiously. Sensitivity analyses should be used across a plausible range of prices. Clinical studies need to be designed to align with health technology assessment requirements, including generic quality of life, and payers should aim for clarity of criteria. Regulators and national payers should aim for compatibility of registers to allow interchange of data. Given the increasing reliance on industry-funded economic analyses, careful critical review is recommended.
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Affiliation(s)
- Antonio Olry de Labry-Lima
- Escuela Andaluza de Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria Ibs, Granada, Spain; CIBER en Epidemiología and Salud Pública (CIBERESP), Spain
| | - Angela Ponce-Polo
- Andalusian Network for the Design & Translation of Advanced Therapies, Sevilla, Spain.
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Kessel L, Kjellberg J, Ibsen R, Rasmussen A, Nissen KR, la Cour M. Longitudinal analysis of health care costs in patients with childhood onset inherited retinal dystrophies compared to healthy controls. BMC Ophthalmol 2022; 22:466. [PMID: 36460996 PMCID: PMC9716977 DOI: 10.1186/s12886-022-02708-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND We evaluated health care costs in patients with childhood onset visual impairment caused by inherited retinal dystrophies (IRD). METHODS The IRD cohort, identified from the Danish Registry of Blind and Partially Sighted Children, was compared to age- and sex-matched controls from the national, Danish population registry. Information on health care expenditures for somatic and psychiatric in- and outpatient services, purchase of prescription medications and paid assistance at home were obtained from national registries for the years 2002-2017. RESULTS We included 412 in the IRD cohort (6,290 person years) and 1656 (25,088 person years) in the control cohort. Average, annual health care expenditures from age 0-48 years of age were €1,488 (SD 4,711) in the IRD cohort and €1,030 (4,639) in the control cohort. The largest difference was for out-patient eye care (13.26 times greater, 95% confidence interval 12.90-13.64). Psychiatric in-patient expenditures were 1.71 times greater (95% CI 1.66-1.76) in the IRD cohort but psychiatric out-patient health care costs were comparable between groups. CONCLUSIONS Health care costs were approximately 40% greater in the IRD cohort compared to an age- and sex-matched sample from the general Danish population. This is relevant in the current situation with a number of trials aimed at treating IRDs using genetically based therapies. Although eye care expenditures were many times greater, they made up < 10% of the total health care expenditures even in the IRD cohort. The reduced costs related to injuries in the visually impaired cohort was a surprising finding but may reflect a reduced propensity to seek medical care rather than a reduced risk of injuries.
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Affiliation(s)
- Line Kessel
- Department of Ophthalmology, Copenhagen University Hospital – Rigshospitalet-Glostrup, Valdemar Hansens Vej 1-23. 2600, Glostrup, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Kjellberg
- grid.492317.a0000 0001 0659 1129VIVE, The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Rikke Ibsen
- grid.492317.a0000 0001 0659 1129VIVE, The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Annette Rasmussen
- Department of Ophthalmology, Copenhagen University Hospital – Rigshospitalet-Glostrup, Valdemar Hansens Vej 1-23. 2600, Glostrup, Denmark
| | - Kamilla Rothe Nissen
- Department of Ophthalmology, Copenhagen University Hospital – Rigshospitalet-Glostrup, Valdemar Hansens Vej 1-23. 2600, Glostrup, Denmark
| | - Morten la Cour
- Department of Ophthalmology, Copenhagen University Hospital – Rigshospitalet-Glostrup, Valdemar Hansens Vej 1-23. 2600, Glostrup, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Battu R, Ratra D, Gopal L. Newer therapeutic options for inherited retinal diseases: Gene and cell replacement therapy. Indian J Ophthalmol 2022; 70:2316-2325. [PMID: 35791112 PMCID: PMC9426045 DOI: 10.4103/ijo.ijo_82_22] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Inherited retinal diseases (IRD) are genotypically and phenotypically varied disorders that lead to progressive degeneration of the outer retina and the retinal pigment epithelium (RPE) eventually resulting in severe vision loss. Recent research and developments in gene therapy and cell therapy have shown therapeutic promise in these hitherto incurable diseases. In gene therapy, copies of a healthy gene are introduced into the host cells via a viral vector. Clinical trials for several genes are underway while treatment for RPE65 called voretigene neparvovec, is already approved and commercially available. Cell therapy involves the introduction of stem cells that can replace degenerated cells. These therapies are delivered to the target tissues, namely the photoreceptors (PR) and RPE via subretinal, intravitreal, or suprachoroidal delivery systems. Although there are several limitations to these therapies, they are expected to slow the disease progression and restore some visual functions. Further advances such as gene editing technologies are likely to result in more precise and personalized treatments. Currently, several IRDs such as retinitis pigmentosa, Stargardt disease, Leber congenital amaurosis, choroideremia, achromatopsia, and Usher syndrome are being evaluated for possible gene therapy or cell therapy. It is important to encourage patients to undergo gene testing and maintain a nationwide registry of IRDs. This article provides an overview of the basics of these therapies and their current status.
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Affiliation(s)
- Rajani Battu
- Aster CMI Hospital; Centre for Eye Genetics and Research, Bengaluru, Karnataka, India
| | - Dhanashree Ratra
- Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Lingam Gopal
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Eye Research, Singapore
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Cost-effectiveness of voretigene neparvovec in the treatment of patients with inherited retinal disease with RPE65 mutation in Switzerland. BMC Health Serv Res 2022; 22:837. [PMID: 35765055 PMCID: PMC9241179 DOI: 10.1186/s12913-022-08211-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022] Open
Abstract
Objective We aimed to evaluate the cost-effectiveness of voretigene neparvovec (VN) compared with standard of care (SoC) for patients with inherited retinal disease (IRD) caused by a biallelic RPE65-mutation. VN is a live, non-replicating adeno-associated virus serotype 2 (AAV2). SoC is best supportive care provided to patients with visual impairment. Patients under SoC may experience progressive vision loss leading to complete blindness. Methods We adapted a previously published Markov cohort model for IRD. An annual cycle length, life-long time horizon, discount rate of 3% for cost and health outcomes, and Swiss health system perspective were used. Data from a randomised controlled phase III trial of VN versus SoC (ClinicalTrials.gov: NCT00999609) were used to estimate transitions between health states in the first year, after which VN patients were assumed to remain for 39 subsequent years in the health state they were in at the end of the first year. After the 40th year for VN patients and 1st year for SoC patients, visual decline was modelled based on observational data on the natural progression of the disease. Quality-adjusted life years (QALYs) were calculated based on an external study which elicited clinicians’ EQ-5D-5L-based utility estimates for IRD patients with a RPE65-mutation. Costs (Swiss Francs (CHF), year 2018-2019) included drug acquisition/ administration, adverse events, testing for sufficient viable retinal cells, and healthcare-related costs of blindness. Societal costs of blindness were added in a complementary analysis. Robustness of the model results were tested in sensitivity and scenario analyses. Results For the base-case, VN resulted in incremental costs per patient of CHF 764’402 (VN: CHF 901’654, SoC: CHF 137’252), incremental blindness-free years of 7.67 (VN: 28.32, SoC: 20.65) and incremental QALYs of 6.73 (VN: 18.35, SoC: 11.62), leading to an incremental cost-effectiveness ratio of CHF 113’526 per QALY gained. In probabilistic sensitivity analysis, the cost-effectiveness of VN was better than CHF 100,000 per QALY gained in 41% of iterations. For the scenario analysis in which a societal perspective was adopted and for which a 50% work-related productivity loss from blindness was assumed, incremental costs of CHF 423,837 and an ICER of CHF 62’947 per QALY gained were produced. The scenario assuming VN treatment effect lasts for 20 years produced an ICER of CHF 156’171 per QALY gained, whereas assuming a life-long VN treatment effect resulted in an ICER of CHF 96’384 per QALY gained. Conclusion The incremental cost-effectiveness ratio of VN compared to the SoC was estimated to be CHF 113’526 and CHF 62’947 per QALY gained, respectively, from a Swiss healthcare system, and societal perspective assuming a 50% productivity loss. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08211-y.
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Kessel L, Kjellberg J, Nissen K, Rasmussen A, la Cour M. Childhood-onset retinal dystrophies reduces life-time income by one third - an individual based socio-economic analysis. Ophthalmic Genet 2022; 43:602-608. [PMID: 35726569 DOI: 10.1080/13816810.2022.2089359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of this study was to evaluate lifetime income, educational level and workforce participation in patients with childhood-onset inherited retinal dystrophies (IRD). MATERIAL AND METHODS The registry-based study using national, Danish databases on education, income, employment and social benefits in a cohort of 515 patients with childhood-onset IRD and without severe systemic comorbidities matched 1:4 to an age- and sex to a control sample of the Danish background population. Socio-economic status was modelled with focus on grade mark points after primary education, highest attained education at 30 years or age, employment and unemployment rate, disability pension and lifetime income. RESULTS At 30 years of age, the proportion of those who had primary education as the highest achieved level was higher in the IRD group (35.4% versus 18.7%) and they were more likely to be receiving a disability pension (OR 11.77) or be unemployed (OR 6.63). Those at work had the same number of work hours as the control group, and the same proportion had obtained a Master or PhD degree (14%). At 30 years of age, income earnings were lower in the IRD group and the lifetime income was reduced by 30%. CONCLUSION A few among those with childhood-onset IRD were able to obtain high educational levels, and many were assigned a disability pension from early adulthood or were unemployed, resulting in a markedly reduced lifetime income although grade mark points from primary education were comparable, suggesting that the difference was not explained by intellectual differences between the groups.
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Affiliation(s)
- Line Kessel
- Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Kjellberg
- VIVE, The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Kamilla Nissen
- Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Anette Rasmussen
- Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Morten la Cour
- Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Simoens S, De Groote K, Boersma C. Critical Reflections on Reimbursement and Access of Advanced Therapies. Front Pharmacol 2022; 13:771966. [PMID: 35662719 PMCID: PMC9157586 DOI: 10.3389/fphar.2022.771966] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background: The health economic literature has questioned the cost-effectiveness and affordability of advanced therapies, proposed adjustments to value assessment frameworks, and discussed the use of outcome-based managed entry agreements and staggered payments in the last few years. The aim of this manuscript is to conduct a critical reflection on assessment criteria and access conditions for reimbursement of advanced therapies. Methods: A narrative review of the peer-reviewed literature and grey literature was conducted in April 2021 by searching PubMed; Google Scholar; policy and legislative documents; websites of health technology assessment agencies, advanced therapy organisations, governmental advanced therapy innovation programmes, consultancy agencies; ISPOR conference abstracts and presentations. Results: Based on the available evidence, this manuscript argues that: a) advanced therapies can be cost-effective at high prices set by manufacturers; b) the economic evaluation framework adopted by many payers under-values these products; c) advanced therapies can be affordable and may not require spread payments; d) outcome-based managed entry agreements are theoretically attractive, but challenging in practice; e) the cost-effectiveness of advanced therapies depends on the outcome-based managed entry agreement and payment approach; f) there is a role for multinational collaborations to manage reimbursement and access of advanced therapies. Conclusions: This manuscript shows that there is no single approach to reimbursement and access of advanced therapies. Instead, we support a more tailored assessment of health economic aspects of advanced therapies, which considers the heterogeneity of these products and their target populations.
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Affiliation(s)
- Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | | | - Cornelis Boersma
- Health Ecore, Zeist, Netherlands.,Open Universiteit, Heerlen, Netherlands.,University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Jayasundera KT, Abuzaitoun RO, Lacy GD, Abalem MF, Saltzman GM, Ciulla TA, Johnson MW. Challenges of Cost-Effectiveness Analyses of Novel Therapeutics for Inherited Retinal Diseases. Am J Ophthalmol 2022; 235:90-97. [PMID: 34433085 PMCID: PMC8861129 DOI: 10.1016/j.ajo.2021.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 07/27/2021] [Accepted: 08/16/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate the challenges and potential improvement strategies of cost-effectiveness analyses performed for therapeutics targeting inherited retinal diseases (IRDs). DESIGN Perspective. METHODS A literature review was conducted with discussion of current limitations and improvement recommendations. RESULTS Cost-effectiveness analysis (CEA) performed for IRD therapeutics has multiple limitations. First, the available methods used to measure health-related quality of life and health utilities can be inaccurate when used in IRDs. Second, the financial burden to patients and society from vision impairment associated with IRDs has been inadequately studied and includes a variety of expenditures ranging from direct costs of IRD specialty health care to indirect expenses associated with daily living activities. Third, our collective understanding is limited in the areas of IRD natural history and health benefits gained from new IRD treatments (eg, gene therapies). In addition, the therapeutic effect from a patient perspective and its duration of action are not fully understood. Due to the scarcity of data, CEA for newly approved therapies has relied on assumptions and creations of predictive models for both costs and health benefits for these new therapeutics in order to calculate the incremental cost-effectiveness ratio. CONCLUSIONS CEA studies performed for IRD therapeutics have been limited by the established health utilities in ophthalmology and the lack of disease-specific information. The assumptions and extrapolations in these studies create substantial uncertainty in incremental cost-effectiveness ratio results. An improved framework is required for CEA of IRD therapeutics in order to determine the cost-effectiveness of each therapy brought from clinical trials to clinical practice.
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Affiliation(s)
- K. Thiran Jayasundera
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall St, Ann Arbor, MI 48105, United States
| | - Rebhi O. Abuzaitoun
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall St, Ann Arbor, MI 48105, United States
| | - Gabrielle D. Lacy
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall St, Ann Arbor, MI 48105, United States
| | - Maria Fernanda Abalem
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall St, Ann Arbor, MI 48105, United States.,Department of Ophthalmology and Otolaryngology, University of Sao Paulo Medical School, Rua, Av. Dr. Enéas Carvalho de Aguiar, 255 - Cerqueira César, São Paulo, São Paulo, 05403-000, Brazil
| | - Gregory M. Saltzman
- Department of Economics and Management, Albion College, 611 E Porter St, Albion, MI 49224, United States.,Department of Health Management and Policy, University of Michigan, Ann Arbor, MI 48105, United States
| | - Thomas A. Ciulla
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University, 1160 W Michigan St, Indianapolis, IN 46202, United States.,Clearside Biomedical, Inc., 900 North Point Pkwy #200, Alpharetta, GA 30005, United States.,Retina Service, Midwest Eye Institute, 10300 N Illinois St #1000, Carmel, IN 46290, Indianapolis, IN, United States
| | - Mark W. Johnson
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall St, Ann Arbor, MI 48105, United States
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Schofield D, Kraindler J, Tan O, Shrestha R, Jelovic D, West S, Ma A, Grigg J, Jamieson RV. Patient-Reported Health-Related Quality of Life in Individuals with Inherited Retinal Diseases. OPHTHALMOLOGY SCIENCE 2022; 2:100106. [PMID: 36246188 PMCID: PMC9560564 DOI: 10.1016/j.xops.2021.100106] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/25/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Deborah Schofield
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, North Ryde, Australia
| | - Joshua Kraindler
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, North Ryde, Australia
- Correspondence: Joshua Kraindler, GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, Level 4, 4 Easten Road, North Ryde, 2109, Australia.
| | - Owen Tan
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, North Ryde, Australia
| | - Rupendra Shrestha
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, North Ryde, Australia
| | - Diana Jelovic
- Eye Genetics Research Unit, Children’s Medical Research Institute, University of Sydney, Sydney, Australia
| | - Sarah West
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, North Ryde, Australia
| | - Alan Ma
- Eye Genetics Research Unit, Children’s Medical Research Institute, University of Sydney, Sydney, Australia
- Sydney Children’s Hospitals Network, Westmead, Australia
| | - John Grigg
- Sydney Children’s Hospitals Network, Westmead, Australia
- Save Sight Institute, University of Sydney, Sydney, Australia
- Sydney Eye Hospital, Sydney, Australia
| | - Robyn V. Jamieson
- Eye Genetics Research Unit, Children’s Medical Research Institute, University of Sydney, Sydney, Australia
- Sydney Children’s Hospitals Network, Westmead, Australia
- Save Sight Institute, University of Sydney, Sydney, Australia
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15
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Qiu T, Pochopień M, Hanna E, Liang S, Wang Y, Han R, Toumi M, Aballéa S. Challenges in the market access of regenerative medicines, and implications for manufacturers and decision-makers: a systematic review. Regen Med 2022; 17:119-139. [PMID: 35042424 DOI: 10.2217/rme-2021-0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aim: Regenerative medicines (RMs) are expected to transform the treatment paradigm of rare, life-threatening diseases, while substantial challenges impede its market access. This study aimed to present these challenges. Materials & methods: Publications identified in the Medline and Embase databases until December 2020 were included. Results: Uncertainties around the relative effectiveness and long-term benefits of RMs are most scrutinized. A new reference case for RMs is questionable, but examining impacts of study perspective, time horizon, discount rate and extrapolation methods on estimates is advised. Establishing reasonable prices of RMs requires increased transparency in the development costs and better values measurements. Outcome-based payments require considerable investments and potential legislative adjustments. Conclusion: Greater flexibility for health technology assessment and economic analyses of RMs is necessary. This comprehensive review may prompt more multi-stakeholder conversations to discuss the optimized strategy for value assessment, pricing and payment in order to accelerate the market access of RMs.
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Affiliation(s)
- Tingting Qiu
- Department of Public Health, Aix-Marseille University, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Michał Pochopień
- Department of Public Health, Aix-Marseille University, 27 Boulevard Jean Moulin, 13385, Marseille, France.,Creativ-Ceutical, 215, Rue du Faubourg St-Honoré, 75008, Paris, France
| | - Eve Hanna
- Creativ-Ceutical, 215, Rue du Faubourg St-Honoré, 75008, Paris, France
| | - Shuyao Liang
- Department of Public Health, Aix-Marseille University, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Yitong Wang
- Department of Public Health, Aix-Marseille University, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Ru Han
- Department of Public Health, Aix-Marseille University, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Mondher Toumi
- Department of Public Health, Aix-Marseille University, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Samuel Aballéa
- Creativ-Ceutical, 215, Rue du Faubourg St-Honoré, 75008, Paris, France
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16
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Ho JK, Borle K, Dragojlovic N, Dhillon M, Kitchin V, Kopac N, Ross C, Lynd LD. Economic Evidence on Potentially Curative Gene Therapy Products: A Systematic Literature Review. PHARMACOECONOMICS 2021; 39:995-1019. [PMID: 34156648 DOI: 10.1007/s40273-021-01051-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 05/22/2023]
Abstract
OBJECTIVE The aim of this review was to summarize all available evidence on the cost effectiveness of potentially curative gene therapies and identify challenges that economic evaluations face in this area. METHODS We conducted a systematic review of four databases (PubMed/MEDLINE, Embase, CINAHL, EconLit) and grey literature sources. We conducted the search on August 23, 2019 and updated it on November 26, 2020. We included all English, French and Spanish language studies that addressed a gene therapy that had received regulatory approval or had entered a phase III trial, and also reported on costs related to the therapy. Critical appraisal was conducted to assess quality of reporting in included studies. RESULTS Fifty-six studies were identified. Of the 42 full economic evaluations, 71% (n = 30) evaluated chimeric antigen receptor T-cell therapies, most used either a Markov model (n = 17, 40%) and/or a partitioned survival model (n = 17, 40%), and 76% (n = 32) adopted a public or private payer perspective. The model characteristics with the greatest impact on cost effectiveness included assumptions about the efficacy of the treatment and the comparators used. CONCLUSION All gene therapies in this review were shown to be more effective than their comparators, although due to high costs not all were considered cost effective at standard cost-effectiveness thresholds. Despite their high cost, some gene therapies have the potential to dominate the alternatives in conditions with high mortality/disability. The choice of comparator and assumptions regarding long-term effectiveness had substantial impacts on cost-effectiveness estimates and need to be carefully considered. Both the quality of inputs and the quality of reporting were highly variable.
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Affiliation(s)
- Joseph Khoa Ho
- Faculty of Pharmaceutical Sciences, Collaboration for Outcomes Research and Evaluation, University of British Columbia, Vancouver, BC, Canada
| | - Kennedy Borle
- Faculty of Pharmaceutical Sciences, Collaboration for Outcomes Research and Evaluation, University of British Columbia, Vancouver, BC, Canada
| | - Nick Dragojlovic
- Faculty of Pharmaceutical Sciences, Collaboration for Outcomes Research and Evaluation, University of British Columbia, Vancouver, BC, Canada
| | - Manrubby Dhillon
- Faculty of Pharmaceutical Sciences, Collaboration for Outcomes Research and Evaluation, University of British Columbia, Vancouver, BC, Canada
| | - Vanessa Kitchin
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nicola Kopac
- Faculty of Pharmaceutical Sciences, Collaboration for Outcomes Research and Evaluation, University of British Columbia, Vancouver, BC, Canada
| | - Colin Ross
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Larry D Lynd
- Faculty of Pharmaceutical Sciences, Collaboration for Outcomes Research and Evaluation, University of British Columbia, Vancouver, BC, Canada.
- Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute, Vancouver, BC, Canada.
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17
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Kang C, Scott LJ. Voretigene Neparvovec: A Review in RPE65 Mutation-Associated Inherited Retinal Dystrophy. Mol Diagn Ther 2021; 24:487-495. [PMID: 32535767 DOI: 10.1007/s40291-020-00475-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Voretigene neparvovec (Luxturna®), a recombinant adeno-associated virus vector-based gene therapy, delivers a functioning copy of the human retinal pigment epithelium-specific 65 kDa (RPE65) gene into retinal cells of patients with reduced or absent levels of RPE65 protein, providing the potential to restore the visual cycle. A single-dose subretinal injection of voretigene neparvovec administered in each eye is approved in several countries worldwide for the treatment of vision loss in adult and paediatric patients with confirmed biallelic RPE65 mutation-associated inherited retinal dystrophy (IRD) and with sufficient viable retinal cells. In the pivotal phase III trial, significant improvements from baseline were seen in the mean bilateral multi-luminance mobility test scores in the voretigene neparvovec group compared with the control group at 1 year. The beneficial effects of voretigene neparvovec treatment were maintained after up to 4 years of follow-up (with follow-up continuing for 15 years). Control recipients were eligible to receive voretigene neparvovec at 1 year, and showed improvements at subsequent follow-ups (≤ 3 years post injection) consistent with those in patients who received voretigene neparvovec at baseline. Most adverse reactions in voretigene neparvovec recipients were transient, asymptomatic and non-serious, and resolved without sequelae (may have been related to voretigene neparvovec, the subretinal injection procedure, concomitant corticosteroid use or a combination thereof). Retinal detachment occurred in one patient at year 4. Although ongoing additional long-term efficacy and safety data are required, voretigene neparvovec is an important novel gene therapy for patients with RPE65 mutation-associated IRD and sufficient viable retinal cells.
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Affiliation(s)
- Connie Kang
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
| | - Lesley J Scott
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand
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18
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Huygens SA, Versteegh MM, Vegter S, Schouten LJ, Kanters TA. Methodological Challenges in the Economic Evaluation of a Gene Therapy for RPE65-Mediated Inherited Retinal Disease: The Value of Vision. PHARMACOECONOMICS 2021; 39:383-397. [PMID: 33604870 PMCID: PMC8009797 DOI: 10.1007/s40273-021-01003-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/23/2021] [Indexed: 05/10/2023]
Abstract
The emergence of gene therapies challenge health economists to evaluate interventions that are often provided to a small patient population with a specific gene mutation in a single dose with high upfront costs and uncertain long-term benefits. The objective of this study was to illustrate the methodological challenges of evaluating gene therapies and their implications by discussing four economic evaluations of voretigene neparvovec (VN) for the treatment of RPE65-mediated inherited retinal disease. The checklist for economic evaluations of gene therapies of Drummond et al. was applied to the economic evaluations of VN performed by US Institute for Clinical and Economic Review, two country adaptations of the company model in the UK and the Netherlands, and another US publication. The main differences in methodological choices and their impact on cost-effectiveness results were assessed and further explored with sensitivity analyses using the Dutch model. To enable comparison between the economic evaluations, costs were converted to US dollars. Different methodological choices were made in the economic evaluations of VN resulting in large differences in the incremental cost-effectiveness ratio varying from US$79,618 to US$643,813 per QALY. The chosen duration of treatment effect, source of utility values, discount rate and model structure had the largest impact on the cost-effectiveness. This study underlines the findings from Drummond et al. that standard methods can be used to evaluate gene therapies. However, given uncertainty about (particularly long-term) outcomes of gene therapies, guidance is required on the acceptable extrapolation of treatment effect of gene therapies and on how to handle the uncertainty around this extrapolation in scenario and sensitivity analyses to aid health technology assessment research and align submissions of future gene therapies.
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Affiliation(s)
- Simone A Huygens
- Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Matthijs M Versteegh
- Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | | | - Tim A Kanters
- Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
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Lorenz B, Tavares J, van den Born LI, Marques JP, Scholl HPN. Current management of patients with RPE65 mutation-associated inherited retinal degenerations (IRDs) in Europe. Results of a multinational survey by the European Vision Institute Clinical Research Network EVICR.net. Ophthalmic Res 2021; 64:740-753. [PMID: 33684911 DOI: 10.1159/000515688] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/04/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Birgit Lorenz
- Department of Ophthalmology, Justus-Liebig-University Giessen, Giessen, Germany
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Joana Tavares
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | | | - João P Marques
- Center for Clinical Trials, Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
| | - Hendrik P N Scholl
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Ophthalmology, University of Basel, Basel, Switzerland
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
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Hu ML, Edwards TL, O'Hare F, Hickey DG, Wang JH, Liu Z, Ayton LN. Gene therapy for inherited retinal diseases: progress and possibilities. Clin Exp Optom 2021; 104:444-454. [PMID: 33689657 DOI: 10.1080/08164622.2021.1880863] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Inherited retinal diseases (IRDs) comprise a heterogeneous group of genetic disorders affecting the retina. Caused by mutations in over 300 genes, IRDs result in visual impairment due to dysfunction and degeneration of photoreceptors, retinal pigment epithelium, or the choroid. Important photoreceptor IRDs include retinitis pigmentosa and Leber congenital amaurosis. Macular dystrophies include Stargardt and Best disease. Currently, IRDs are largely incurable but the landscape of treatment options is rapidly changing for these diseases which, untreated, result in severe visual impairment and blindness.Advances in DNA delivery to the retina and improved genetic diagnosis of IRDs have led to a new era of research into gene therapy for these vision-threatening disorders. Gene therapy is a compelling approach due to the monogenic nature of most IRDs, with the retina being a favourable target for administering genetic vectors due to its immunoprivileged environment, direct visibility, and multiple methods to assess sensitivity and function. Generally, retinal gene therapy involves a subretinal or intravitreal injection of a viral vector, which infects target cells to deliver a therapeutic gene, or transgene. A gene augmentation strategy introduces a functioning copy of a gene to restore expression of a mutated gene, whereas a gene-editing strategy aims to directly edit and correct the mutation. Common delivery vectors include adeno-associated virus (AAV) and lentivirus.Voretigene neparvovec-rzyl (Luxturna) became the first FDA-approved direct gene therapy in December 2017, and the Australian TGA followed suit in August 2020. More are projected to follow, with clinical trials underway for many other IRDs.This review provides an overview of gene therapy for IRDs, including current progress and challenges. A companion article in this issue details target patient populations for IRD gene therapy, and how optometrists can assist in assessing individuals who may be eligible for current and future therapies.
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Affiliation(s)
- Monica L Hu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Thomas L Edwards
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Department of Surgery (Ophthalmology), Faculty of Medicine, Dentistry and Health Sciences, the University of Melbourne, Melbourne, Australia
| | - Fleur O'Hare
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Department of Surgery (Ophthalmology), Faculty of Medicine, Dentistry and Health Sciences, the University of Melbourne, Melbourne, Australia.,Department of Optometry and Vision Sciences, Faculty of Medicine, Dentistry and Health Sciences, the University of Melbourne, Melbourne, Australia
| | - Doron G Hickey
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Jiang-Hui Wang
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Zhengyang Liu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Lauren N Ayton
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Department of Surgery (Ophthalmology), Faculty of Medicine, Dentistry and Health Sciences, the University of Melbourne, Melbourne, Australia.,Department of Optometry and Vision Sciences, Faculty of Medicine, Dentistry and Health Sciences, the University of Melbourne, Melbourne, Australia
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Lorenz B, Tavares J, van den Born LI, Marques JP, Scholl HPN. Current Management of Inherited Retinal Degeneration Patients in Europe: Results of a Multinational Survey by the European Vision Institute Clinical Research Network. Ophthalmic Res 2021; 64:622-638. [PMID: 33465765 DOI: 10.1159/000514540] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/15/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE An increasing number of gene therapies are developed for Inherited Retinal Degenerations (IRD). To date, 1 treatment has been approved for clinical use (FDA USA 2017, EMA Europe 2018, MoHAP UAE 2019, SFDA Saudi Arabia 2019, Swiss Medic Switzerland 2020, TGA Australia 2020, and BFR Brazil 2020). While such therapies do not provide complete cure, they may halt degeneration or partially restore function. Identification of well-characterized patients is an emerging need. We conducted the first multinational survey to understand the management of IRDs in Europe. METHODS An electronic survey questionnaire containing 112 questions was developed and sent to the 101 EVICR.net clinical centers (14 European countries and Israel). RESULTS The overall response rate was 49%. Only 14% of responding centers do not see IRD patients; 52% that manage IRD patients follow ≥200 patients, 16% > 1,000. Databases exist in 86% of the centers; of these, 75% are local files, 28% local Web-based database, and 19% national Web-based. IRD patients are referred to EVICR.net centers mainly by general ophthalmologists, patient self-referrals, and medical retina specialists. Most IRD patients are first seen in adulthood. Most prominent signs and symptoms depend on the age of onset, for example, nystagmus in infancy, or night blindness, and reduced visual acuity at older age. The time from inquiring for first appointment and clinical diagnosis varies among countries: in 29% of centers, the mean time is <4 weeks, although can be up to 35 months in others. The time to genetic diagnosis is ≥4 weeks, the maximum 10 years, likely depending on access to genetic testing, and the improvement of the tests available. Comprehensive eye examination always includes autofluorescence imaging and perimetry (86% static, 76% kinetic, and 21% microperimetry), and frequently optical coherence tomography (OCT) (95%), electroretinography (93%), and fundus photography (93%). Identified genotypes were reported in 40-80% patients by 69% of centers, and in 80-100% by 5%. Genetic testing is provided by public health insurance in 77% of centers, private health insurance in 38%, center budget in 13%, research funds in 18%; and 15% of centers do not have access to genetic testing. CONCLUSION At the start of this era of ocular gene therapy for IRD patients, this first international survey on management of IRDs in Europe highlights significant heterogeneity between centers and across countries and provides important baseline data for researchers, clinicians, pharmaceutical companies, and investors.
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Affiliation(s)
- Birgit Lorenz
- Department of Ophthalmology, Justus-Liebig-University Giessen, Giessen, Germany.,Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Joana Tavares
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | | | - João P Marques
- Center for Clinical Trials, Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal.,Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.,Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
| | - Hendrik P N Scholl
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland.,Department of Ophthalmology, University of Basel, Basel, Switzerland.,Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
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Gao J, Hussain RM, Weng CY. Voretigene Neparvovec in Retinal Diseases: A Review of the Current Clinical Evidence. Clin Ophthalmol 2020; 14:3855-3869. [PMID: 33223822 PMCID: PMC7671481 DOI: 10.2147/opth.s231804] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/21/2020] [Indexed: 12/26/2022] Open
Abstract
Subretinal gene therapy trials began with the discovery of RPE65 variants and their association with Leber congenital amaurosis. The RPE65 protein is critical for the normal functioning of the visual phototransduction cascade. RPE65 gene knockout animal models were developed and showed similar diseased phenotypes to their human counterparts. Proof of concept studies were carried out in these animal models using subretinal RPE65 gene replacement therapy, resulting in improvements in various visual function markers including electroretinograms, pupillary light responses, and object avoidance behaviors. Positive results in animal models led to Phase 1 human studies using adeno-associated viral vectors. Results in these initial human studies also showed positive impact on visual function and acceptable safety. A landmark Phase 3 study was then conducted by Spark Therapeutics using a dose of 1.5 x1011 vector genomes after dose-escalation studies confirmed its efficacy and safety. Multi-luminance mobility testing was used to measure the primary efficacy endpoint due to its excellent reliability in detecting the progression of inherited retinal diseases. After the study met its primary endpoint, the Food and Drug Administration approved voretigene neparvovec (Luxturna®) for use in RPE65-associated inherited retinal diseases.
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Affiliation(s)
- Jie Gao
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | | | - Christina Y Weng
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
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Uhrmann MF, Lorenz B, Gissel C. Cost Effectiveness of Voretigene Neparvovec for RPE65-Mediated Inherited Retinal Degeneration in Germany. Transl Vis Sci Technol 2020; 9:17. [PMID: 32879773 PMCID: PMC7442871 DOI: 10.1167/tvst.9.9.17] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/06/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Voretigene Neparvovec-rzyl (VN) is the first available treatment for biallelic RPE65 mutation-associated inherited retinal degeneration, which is usually associated with infancy-onset severe visual impairment and complete blindness during the third life decade. We aim to estimate the cost effectiveness of VN in Germany considering medication costs of €410,550 per eye and potential indirect cost offsets by higher labor force participation. Methods We developed an individual patient sampling model to simulate patients over their lifetime. In a Monte Carlo analysis, 1000 simulations are performed. Cycle length of the two-state Markov model is 1 year. For each cycle, visual field and best-corrected visual acuity are tracked, compared with natural progression and converted to quality of life. Direct and indirect costs are recorded and the incremental cost-utility ratio is calculated. Results In the base case scenario, VN provides 4.82 additional quality-adjusted life-years over a patient's lifetime at an incremental cost-utility ratio of €156,853 per additional quality-adjusted life-year gained. Sensitivity analyses show the robustness of the results when altering treatment effect duration, discounting of quality-adjusted life-years and costs, direct costs, and natural progression. Conclusions Under a lifetime perspective, VN proves to be cost effective for the German statutory health insurance system despite high initial treatment costs. Because VN has important implications for future gene therapies, cost-utility analyses have high economic relevance from a societal perspective. Translational Relevance Our research analyzes the value of a gene augmentation therapy in clinical care in terms of quality of life gains for patients with blindness from retinal degeneration.
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Affiliation(s)
- Matthias Fritz Uhrmann
- Department of Ophthalmology, Justus Liebig University Giessen and University Hospital of Giessen and Marburg, Campus Giessen, Germany
- Department of Health Economics, Justus Liebig University Giessen, Giessen, Germany
| | - Birgit Lorenz
- Department of Ophthalmology, Justus Liebig University Giessen and University Hospital of Giessen and Marburg, Campus Giessen, Germany
| | - Christian Gissel
- Department of Health Economics, Justus Liebig University Giessen, Giessen, Germany
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