Cost-Effectiveness of Bevacizumab and Ranibizumab for Newly Diagnosed Neovascular Macular Degeneration

• Published in: Ophthalmology (Rochester, Minn.) Vol. 121; no. 4; pp. 936 - 945
• Main Authors: Stein, Joshua D., MD, MS, Newman-Casey, Paula Anne, MD, MS, Mrinalini, Tavag, MPH, Lee, Paul P., MD, JD, Hutton, David W., PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2014
• Subjects: Aged, 80 and over; Angiogenesis Inhibitors - adverse effects; Angiogenesis Inhibitors - economics; Angiogenesis Inhibitors - therapeutic use; Antibodies, Monoclonal, Humanized - adverse effects; Antibodies, Monoclonal, Humanized - economics; Antibodies, Monoclonal, Humanized - therapeutic use; Bevacizumab; Cost-Benefit Analysis; Drug Costs; Health Care Costs; Humans; Markov Chains; Models, Theoretical; Ophthalmology; Quality-Adjusted Life Years; Ranibizumab; Vascular Endothelial Growth Factor A - antagonists & inhibitors; Vascular Endothelial Growth Factor A - economics; Visual Acuity - physiology; Wet Macular Degeneration - drug therapy; Wet Macular Degeneration - economics
• ISSN: 0161-6420; 1549-4713
• DOI: 10.1016/j.ophtha.2013.10.037

Purpose We sought to determine the most cost-effective treatment for patients with newly diagnosed neovascular macular degeneration: monthly or as-needed bevacizumab injections, or monthly or as-needed ranibizumab injections. Design Cost-effectiveness analysis. Participants Hypothetical cohort of 80-year-old patients with newly diagnosed neovascular macular degeneration. Methods Using a mathematical model with a 20-year time horizon, we compared the incremental cost-effectiveness of treating a hypothetical cohort of 80-year-old patients with newly diagnosed neovascular macular degeneration using monthly bevacizumab, as-needed bevacizumab, monthly ranibizumab, or as-needed ranibizumab. Data came from the Comparison of Age-related macular degeneration Treatment Trial (CATT), the Medicare Fee Schedule, and the medical literature. Main Outcome Measures Costs, quality-adjusted life-years (QALYs), and incremental costs per QALY gained. Results Compared with as-needed bevacizumab, the incremental cost-effectiveness ratio of monthly bevacizumab is $242 357/QALY. Monthly ranibizumab gains an additional 0.02 QALYs versus monthly bevacizumab at an incremental cost-effectiveness ratio of >$10 million/QALY. As-needed ranibizumab was dominated by monthly bevacizumab, meaning it was more costly and less effective. In sensitivity analyses assuming a willingness to pay of $100 000/QALY, the annual risk of serious vascular events would have to be ≥2.5 times higher with bevacizumab than that observed in the CATT trial for as-needed ranibizumab to have an incremental cost-effectiveness ratio of <$100 000/QALY. In another sensitivity analysis, even if every patient receiving bevacizumab experienced declining vision by 1 category (e.g., from 20/25–20/40 to 20/50–20/80) after 2 years but every patient receiving ranibizumab retained their vision level, as-needed ranibizumab would have an incremental cost-effectiveness ratio of $97 340/QALY. Conclusions Even after considering the potential for differences in risks of serious adverse events and therapeutic effectiveness, bevacizumab confers considerably greater value than ranibizumab for the treatment of neovascular macular degeneration.