This model-based cost-effectiveness analysis evaluated photobiomodulation (PBM) vs. standard care for bilateral intermediate dry AMD in adults (BCVA 20/32–20/100) over a 10-year horizon, using a 5-state Markov model informed by 24-month LIGHTSITE III trial data and AREDS natural history rates.
PBM produced 5.244 discounted QALYs at an incremental cost of $29,556 over 10 years (ICER: $73,910/QALY), falling below both the $100,000 and $150,000 US willingness-to-pay thresholds. The ICER remained cost-effective across most scenarios ($36,700–$117,694/QALY), except the $5,000/course pricing scenario. The 5-year national budget impact was $25.0 billion at 20% uptake.
- The 71.7% relative GA reduction driving the model is from a single trial (LIGHTSITE III) and has not been independently replicated. - Quality-of-life inputs relied on indirect VFQ-25-to-EQ-5D conversion rather than prospectively collected EQ-5D data. - The 10-year model extrapolates well beyond the 24-month trial follow-up, introducing structural uncertainty.
At current US pricing assumptions, PBM appears cost-effective for intermediate dry AMD and may warrant coverage consideration — but clinicians and payers should wait for independent replication of the GA reduction benefit before broad adoption. The large projected budget impact ($25B over 5 years at 20% uptake) underscores the need for robust confirmatory evidence.
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