Ranibizumab (Lucentis) versus bevacizumab (Avastin): modelling cost effectiveness

• Published in: British journal of ophthalmology Vol. 91; no. 9; pp. 1244 - 1246
• Main Authors: Raftery, James, Clegg, Andrew, Jones, Jeremy, Tan, Seng Chuen, Lotery, Andrew
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.09.2007; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Aged; Aged, 80 and over; Antibodies, Monoclonal - economics; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Bevacizumab; Biological and medical sciences; Cost-Benefit Analysis; Drug Costs - statistics & numerical data; Humans; Macular Degeneration - drug therapy; Macular Degeneration - economics; Macular Degeneration - physiopathology; Markov Chains; Medical sciences; Miscellaneous; Models, Econometric; Ophthalmology; Quality-Adjusted Life Years; Ranibizumab; Treatment Outcome; Visual Acuity; Immunomodulator; Health economy; Ranibizumab; Ophthalmology; Modeling; Comparative study; Cost efficiency analysis
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjo.2007.116616

Two new drugs provide startling benefits in the treatment of age-related macular degeneration (AMD). The clinical and cost effectiveness of ranibizumab (Lucentis) was compared to that of bevacizumab (Avastin), which costs up to 100 times less. A cost effectiveness model was developed to assess the cost per quality adjusted life year (QALY) over 10 years. For predominantly classic AMD, the efficacy of bevacizumab relative to ranibizumab would have to be around 40% for the latter to achieve £30k per QALY, a NICE threshold. Similar but worse results applied to the other main forms of AMD, minimally occult and occult with no classic lesions. The price of ranibizumab would have to be drastically reduced for it to be cost effective. Continued unlicensed use of bevacizumab raises ethical, legal and policy questions. Public pressure may be the most potent weapon in persuading Genentech to license bevacizumab for AMD.