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A value-based medicine analysis of ranibizumab for the treatment of subfoveal neovascular macular degeneration.
Ophthalmology. 2008 Jun; 115(6):1039-1045.e5.O

Abstract

OBJECTIVE

To assess the conferred value and average cost-utility (cost-effectiveness) for intravitreal ranibizumab used to treat occult/minimally classic subfoveal choroidal neovascularization associated with age-related macular degeneration (AMD).

DESIGN

Value-based medicine cost-utility analysis.

PARTICIPANTS

MARINA (Minimally Classic/Occult Trial of the Anti-Vascular Endothelial Growth Factor Antibody Ranibizumab in the Treatment of Neovascular AMD) Study patients utilizing published primary data.

METHODS

Reference case, third-party insurer perspective, cost-utility analysis using 2006 United States dollars.

MAIN OUTCOME MEASURES

Conferred value in the forms of (1) quality-adjusted life-years (QALYs) and (2) percent improvement in health-related quality of life. Cost-utility is expressed in terms of dollars expended per QALY gained. All outcomes are discounted at a 3% annual rate, as recommended by the Panel on Cost-effectiveness in Health and Medicine. Data are presented for the second-eye model, first-eye model, and combined model.

RESULTS

Twenty-two intravitreal injections of 0.5 mg of ranibizumab administered over a 2-year period confer 1.039 QALYs, or a 15.8% improvement in quality of life for the 12-year period of the second-eye model reference case of occult/minimally classic age-related subfoveal choroidal neovascularization. The reference case treatment cost is $52652, and the cost-utility for the second-eye model is $50691/QALY. The quality-of-life gain from the first-eye model is 6.4% and the cost-utility is $123887, whereas the most clinically simulating combined model yields a quality-of-life gain of 10.4% and cost-utility of $74169.

CONCLUSIONS

By conventional standards and the most commonly used second-eye and combined models, intravitreal ranibizumab administered for occult/minimally classic subfoveal choroidal neovascularization is a cost-effective therapy. Ranibizumab treatment confers considerably greater value than other neovascular macular degeneration pharmaceutical therapies that have been studied in randomized clinical trials.

Authors+Show Affiliations

Center for Value-Based Medicine, Flourtown, Pennsylvania 19031, USA. valuebasedmedicine.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial, Phase III
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17976724

Citation

Brown, Melissa M., et al. "A Value-based Medicine Analysis of Ranibizumab for the Treatment of Subfoveal Neovascular Macular Degeneration." Ophthalmology, vol. 115, no. 6, 2008, pp. 1039-1045.e5.
Brown MM, Brown GC, Brown HC, et al. A value-based medicine analysis of ranibizumab for the treatment of subfoveal neovascular macular degeneration. Ophthalmology. 2008;115(6):1039-1045.e5.
Brown, M. M., Brown, G. C., Brown, H. C., & Peet, J. (2008). A value-based medicine analysis of ranibizumab for the treatment of subfoveal neovascular macular degeneration. Ophthalmology, 115(6), 1039-e5.
Brown MM, et al. A Value-based Medicine Analysis of Ranibizumab for the Treatment of Subfoveal Neovascular Macular Degeneration. Ophthalmology. 2008;115(6):1039-1045.e5. PubMed PMID: 17976724.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A value-based medicine analysis of ranibizumab for the treatment of subfoveal neovascular macular degeneration. AU - Brown,Melissa M, AU - Brown,Gary C, AU - Brown,Heidi C, AU - Peet,Jonathan, Y1 - 2007/11/05/ PY - 2007/01/22/received PY - 2007/08/20/revised PY - 2007/08/20/accepted PY - 2007/11/3/pubmed PY - 2008/6/13/medline PY - 2007/11/3/entrez SP - 1039 EP - 1045.e5 JF - Ophthalmology JO - Ophthalmology VL - 115 IS - 6 N2 - OBJECTIVE: To assess the conferred value and average cost-utility (cost-effectiveness) for intravitreal ranibizumab used to treat occult/minimally classic subfoveal choroidal neovascularization associated with age-related macular degeneration (AMD). DESIGN: Value-based medicine cost-utility analysis. PARTICIPANTS: MARINA (Minimally Classic/Occult Trial of the Anti-Vascular Endothelial Growth Factor Antibody Ranibizumab in the Treatment of Neovascular AMD) Study patients utilizing published primary data. METHODS: Reference case, third-party insurer perspective, cost-utility analysis using 2006 United States dollars. MAIN OUTCOME MEASURES: Conferred value in the forms of (1) quality-adjusted life-years (QALYs) and (2) percent improvement in health-related quality of life. Cost-utility is expressed in terms of dollars expended per QALY gained. All outcomes are discounted at a 3% annual rate, as recommended by the Panel on Cost-effectiveness in Health and Medicine. Data are presented for the second-eye model, first-eye model, and combined model. RESULTS: Twenty-two intravitreal injections of 0.5 mg of ranibizumab administered over a 2-year period confer 1.039 QALYs, or a 15.8% improvement in quality of life for the 12-year period of the second-eye model reference case of occult/minimally classic age-related subfoveal choroidal neovascularization. The reference case treatment cost is $52652, and the cost-utility for the second-eye model is $50691/QALY. The quality-of-life gain from the first-eye model is 6.4% and the cost-utility is $123887, whereas the most clinically simulating combined model yields a quality-of-life gain of 10.4% and cost-utility of $74169. CONCLUSIONS: By conventional standards and the most commonly used second-eye and combined models, intravitreal ranibizumab administered for occult/minimally classic subfoveal choroidal neovascularization is a cost-effective therapy. Ranibizumab treatment confers considerably greater value than other neovascular macular degeneration pharmaceutical therapies that have been studied in randomized clinical trials. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/17976724/A_value_based_medicine_analysis_of_ranibizumab_for_the_treatment_of_subfoveal_neovascular_macular_degeneration_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(07)00937-2 DB - PRIME DP - Unbound Medicine ER -