@article {Dakine005094, author = {Helen A Dakin and Sarah Wordsworth and Chris A Rogers and Giselle Abangma and James Raftery and Simon P Harding and Andrew J Lotery and Susan M Downes and Usha Chakravarthy and Barnaby C Reeves and on behalf of the IVAN Study Investigators}, title = {Cost-effectiveness of ranibizumab and bevacizumab for age-related macular degeneration: 2-year findings from the IVAN randomised trial}, volume = {4}, number = {7}, elocation-id = {e005094}, year = {2014}, doi = {10.1136/bmjopen-2014-005094}, publisher = {British Medical Journal Publishing Group}, abstract = {Objective To assess the incremental cost and cost-effectiveness of continuous and discontinuous regimens of bevacizumab (Avastin) and ranibizumab (Lucentis) for neovascular age-related macular degeneration (nAMD) from a UK National Health Service (NHS) perspective. Design A within-trial cost-utility analysis with a 2-year time horizon, based on a multicentre factorial, non-inferiority randomised controlled trial. Setting 23 hospital ophthalmology clinics. Participants 610 patients aged >=50 years with untreated nAMD in the study eye. Interventions 0.5 mg ranibizumab or 1.25 mg bevacizumab given continuously (monthly) or discontinuously (as-needed) for 2 years. Main outcome measures Quality-adjusted life-years (QALYs). Results Total 2-year costs ranged from {\textsterling}3002/patient ($4700; 95\% CI {\textsterling}2601 to {\textsterling}3403) for discontinuous bevacizumab to {\textsterling}18 590/patient ($29 106; 95\% CI {\textsterling}18 258 to {\textsterling}18 922) for continuous ranibizumab. Ranibizumab was significantly more costly than bevacizumab for both continuous (+{\textsterling}14 989/patient ($23 468); 95\% CI {\textsterling}14 522 to {\textsterling}15 456; p\<0.001) and discontinuous treatment (+{\textsterling}8498 ($13 305); 95\% CI {\textsterling}7700 to {\textsterling}9295; p\<0.001), with negligible difference in QALYs. Continuous ranibizumab would only be cost-effective compared with continuous bevacizumab if the NHS were willing to pay {\textsterling}3.5 million ($5.5 million) per additional QALY gained. Patients receiving continuous bevacizumab accrued higher total costs (+{\textsterling}599 ($938); 95\% CI {\textsterling}91 to {\textsterling}1107; p=0.021) than those receiving discontinuous bevacizumab, but also accrued non-significantly more QALYs (+0.020; 95\% CI -0.032 to 0.071; p=0.452). Continuous bevacizumab therefore cost {\textsterling}30 220 ($47 316) per QALY gained versus discontinuous bevacizumab. However, bootstrapping demonstrated that if the NHS is willing to pay {\textsterling}20 000/QALY gained, there is a 37\% chance that continuous bevacizumab is cost-effective versus discontinuous bevacizumab. Conclusions Ranibizumab is not cost-effective compared with bevacizumab, being substantially more costly and producing little or no QALY gain. Discontinuous bevacizumab is likely to be the most cost-effective of the four treatment strategies evaluated in this UK trial, although there is a 37\% chance that continuous bevacizumab is cost-effective. Trial registration number ISRCTN92166560.}, issn = {2044-6055}, URL = {https://bmjopen.bmj.com/content/4/7/e005094}, eprint = {https://bmjopen.bmj.com/content/4/7/e005094.full.pdf}, journal = {BMJ Open} }