RESEARCH ARTICLE Treatment Options for Age-Related Macular Degeneration: A Budget Impact Analysis from the Perspective of the Brazilian Public Health System

Background Age-related macular degeneration (AMD) is a disease that causes reduced visual acuity and blindness. The new treatment options for AMD are not provided by the Brazilian public health system. Objective To conduct a budget impact analysis of three scenarios for the introduction of AMD treat-ments: all the medications (verteporfin, ranibizumab, and bevacizumab–the reference sce-nario), ranibizumab alone, and bevacizumab alone. Methods The basic assumption was that the Brazilian public health system would treat the entire tar-get population with AMD aged> 70 years between 2008 and 2011. The size of the popula-tion of interest was estimated from official population projections and the prevalence of the disease was obtained from a systematic review. Medication prices were estimated by weighting their market values with correction factors to take account of the public procure-ment policy. The possibility of aliquoting bevacizumab was also considered. A panel of experts was consulted to estimate the market share of the different medications for the ref-erence scenario. The incremental costs of the ranibizumab-alone and bevacizumab-alone scenarios compared to the reference scenario were calculated. Univariate sensitivity analy-ses were run to check the robustness of the model. Results In four years, the Brazilian public health system would have treated 1,136,349 individuals with AMD. The annual costs of treating one patient would have been US$476.65 fo