Improvement in quality of life from photodynamic therapy: a Canadian perspective

• Published in: Canadian journal of ophthalmology 2001-10, Vol.36 (6), p.332-338
• Main Authors: Sharma, Sanjay, MD, FRCSC, MSc(Epid), MBA, Hollands, Hussein, MSc(Epid), Brown, Gary C., MD, MBA, Brown, Melissa M., MN, MD, MBA, Shah, Gaurav K., MD, Sharma, Susan M., MD
• Format: Article
• Language: English
• Subjects: age-related macular degeneration; Biological and medical sciences; Canada; Choroidal Neovascularization - drug therapy; Choroidal Neovascularization - etiology; Cohort Studies; cost-effectiveness; Decision Support Techniques; Diseases of the eye; health policy; Humans; Internal Medicine; Macular Degeneration - complications; Medical sciences; Monte Carlo Method; Ophthalmology; Photochemotherapy - methods; photodynamic therapy; Photosensitizing Agents - therapeutic use; Porphyrins - therapeutic use; Quality of Life; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); verteporfin; Visual Acuity; Visudyne
• ISSN: 0008-4182; 1715-3360
• DOI: 10.1016/S0008-4182(01)80120-4

Abstract Background: The Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) Study showed that at I year, photodynamic therapy significantly reduced the chances of severe visual loss (15 letters or greater) compared with placebo treatment in patients with “predominantly classic” subfoveal choroidal neovascularization (CNV). We performed a study to determine the expected gain in quality of life associated with photodynamic therapy for the treatment of subfoveal CNV in a Canadian cohort of patients with age-related macular degeneration. Methods: We created a decision analysis model to determine the incremental gain in quality-adjusted life years (QALYs) associated with photodynamic therapy over placebo over a 2-year period. The analysis was conducted using efficacy data derived from the TAP Study and patient-based utilities collected by means of the time tradeoff technique. We conducted one-way and two-way sensitivity analyses to determine the robustness of our model. A Monte Carlo simulation was used to determine whether the observed gain in QALYs with photodynamic therapy was significant. Results: Photodynamic therapy was associated with a relative increase in QALYs of 11.3% compared with placebo. In one-way and two-way sensitivity analyses, the relative increase in quality of life associated with photodynamic therapy ranged from 4.2% to 25.7%. The Monte Carlo simulation showed that the gain in QALYs conferred from photodynamic therapy was statistically significant ( p < 0.001). Interpretation: Photodynamic therapy improves the quality of life of Canadians with predominantly classic subfoveal CNV secondary to agerelated macular degeneration.