Effective treatments have emerged recently for age-related macular degeneration, but a study by Dr. William E. Smiddy of the University of Miami has shown that the costs of those treatments are high and seem exorbitant relative to those for other commonly treated retinal disorders.

Smiddy reviewed several key clinical studies of age-related macular degeneration treatments and estimated the cost of each treatment per line of vision that patients are saved, based on Medicare-allowable costs. He also showed where the money goes. He noted that the newest pharmaceutical-based treatments have greatly improved patient prognosis and disease management. However, they cost significantly more than others, including laser treatments, the previous standard. For example, the cost per line of vision saved was $997 for laser treatment of extrafoveal choroidal neovascularization, a type of age-related macular degeneration in which new blood vessels block vision. In contrast, the highest cost per line of vision saved was $12,482 for injections of pegaptanib, a pharmaceutical. Smiddy does not suggest that less effective laser treatments should remain the standard; rather, he points out the markedly higher price paid to pharmaceutical companies for treating this common condition.

He also evaluated the costs per line of vision saved per each remaining year of patients’ lives. These costs ranged from $77 to $1248 for age-related macular degeneration, whereas treatments for comparative eye diseases cost only $21 to $195.

Smiddy concluded that such high costs will adversely affect the availability and development of treatments for other established diseases by shifting the finite health care resources toward age-related macular degeneration treatments. He called for a dialogue on controlling and coping with this conflict. (Ophthalmology, May 2007, pp. 847-854.)