Original articleCost-Effectiveness of Bevacizumab and Ranibizumab for Newly Diagnosed Neovascular Macular Degeneration
Section snippets
Study Design
We developed a Markov model to capture the total costs and HRQL for patients with newly diagnosed neovascular AMD under 4 treatment options: monthly bevacizumab injections, as-needed bevacizumab injections, monthly ranibizumab injections, and as-needed ranibizumab injections. A societal perspective was taken to encompass all parties affected by the treatment choice: patients, providers, and payers. The model followed a hypothetical cohort of patients aged 80 years (the mean age for neovascular
Base Model
Over 20 years, the expected costs for a single patient with newly diagnosed neovascular AMD receiving monthly bevacizumab, as-needed bevacizumab, monthly ranibizumab, and as-needed ranibizumab were $79 771, $65 267, $257 496, and $163 694, and the QALYs for a patient receiving these treatments were 6.66, 6.60, 6.68, and 6.64, respectively. The ICER of monthly bevacizumab over as-needed bevacizumab was $242 357/QALY. The ICER of monthly ranibizumab over as-needed bevacizumab was
Discussion
As health care policymakers aim to curtail rising health care costs, treatments that confer the greatest relative value must be identified. Using data from CATT, we find that, compared with as-needed dosing of bevacizumab, the ICERs of monthly bevacizumab and monthly ranibizumab for neovascular AMD are $242 357/QALY and $10 708 377/QALY, respectively. Furthermore, as-needed ranibizumab was dominated by as-needed bevacizumab, meaning that as-needed ranibizumab is more costly and less effective.
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2019, OphthalmologyCitation Excerpt :Off-label intravitreal bevacizumab was found to be highly cost-effective compared with ranibizumab.46 In patients 80 years of age and older, the CATT study also found that bevacizumab offered much greater value than ranibizumab.47 For monthly treatment, the incremental cost-effectiveness of ranibizumab versus bevacizumab was estimated at more than $10 million per quality-adjusted life year (QALY) gained over a 20-year period compared with $240 000/QALY for as-needed treatment.47
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2018, Ophthalmology RetinaCitation Excerpt :Interventions with a cost utility of less than $100 000/QALY generally are regarded as cost effective and those less than $50 000/QALY are regarded as very cost effective.31 In the treatment of age-related macular degeneration32 and diabetic macular edema,9 bevacizumab consistently is regarded as a cost-effective treatment option. As expected, with prolonged use, ranibizumab and aflibercept become increasingly prohibitive in terms of cost per QALY.14
Supplemental material is available at www.aaojournal.org
This research has been accepted as a thesis for the American Ophthalmological Society.
Financial Disclosures: The authors have no proprietary or commercial interest in any of the materials discussed in this article. Paul P. Lee, MD, JD, is a consultant to Genentech; however, this company was not involved in the conception, design, or conduct of this study.
Funding/support: National Eye Institute K23 Mentored Clinician Scientist Award (1K23EY019511-01); Grant Number P30DK092926 from the National Institute of Diabetes and Digestive and Kidney Diseases; Research to Prevent Blindness “Physician Scientist” Award; and an unrestricted grant from Research to Prevent Blindness.