Cost-Effectiveness of Photobiomodulation for Intermediate Dry Age-Related Macular Degeneration: A Model-Based Analysis Using the LIGHTSITE III 24-Month Trial.

Authors

Arjun Watane, Andre Witkin, Jeffrey Heier, Chirag Shah

Published in

American journal of ophthalmology. Jul 25, 2026. Epub Jul 25, 2026.

Abstract

To evaluate the cost-effectiveness of photobiomodulation (PBM) for intermediate dry age-related macular degeneration (AMD) from the US healthcare payer perspective, using 24-month LIGHTSITE III trial data.
Model-based cost-effectiveness analysis using a 5-state Markov model with 6-month cycles over a 10-year horizon, discounting costs and outcomes at 3% annually.
Modeled cohort of adults with bilateral intermediate dry AMD and best-corrected visual acuity (BCVA) 20/32-20/100, consistent with LIGHTSITE III eligibility.
Transition probabilities were derived from LIGHTSITE III 24-month outcomes and AREDS natural history data. Costs were derived from 2025 Medicare Physician Fee Schedule and published claims-based sources. One-way and probabilistic sensitivity analyses, a societal perspective, a two-year limited treatment scenario, and a 5-year national budget impact analysis were conducted.
Quality-adjusted life-years (QALYs) derived from published visual acuity-to-utility mapping and VFQ-25-to-EQ-5D conversion of LIGHTSITE III quality-of-life data; incremental cost-effectiveness ratio (ICER) as cost per QALY; 5-year national budget impact.
PBM yielded 5.244 discounted QALYs at an incremental cost of $29,556 over 10 years, producing a base-case ICER of $73,910 per QALY, below both the $100,000 and $150,000 US willingness-to-pay thresholds. The ICER ranged from $36,700 ($1,000/course) to $117,694 per QALY (30% geographic atrophy [GA] reduction) across clinically realistic scenarios. Only the $5,000/course scenario exceeded both thresholds. The 5-year cumulative national budget impact was $25.0 billion at 20% uptake.
PBM is cost-effective at conventional US willingness-to-pay thresholds, driven primarily by a 71.7% relative reduction in incident GA at 24 months. These findings support coverage consideration of PBM for intermediate dry AMD, pending independent replication of the GA reduction and prospective EQ-5D data collection.

PMID:
42501959
Bibliographic data and abstract were imported from PubMed on 26 Jul 2026.

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