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Cost-effectiveness of bevacizumab and ranibizumab for newly diagnosed neovascular macular degeneration (an American Ophthalmological Society thesis).
Trans Am Ophthalmol Soc. 2013 Sep; 111:56-69.TA

Abstract

PURPOSE

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.

METHODS

Using a Markov 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 Schedules, and the medical literature.

RESULTS

Compared with as-needed bevacizumab, the incremental cost-effectiveness ratio of monthly bevacizumab is $242,357 per quality-adjusted life year (QALY). Monthly ranibizumab gains an additional 0.02 QALYs vs monthly bevacizumab at an incremental cost-effectiveness ratio of more than $10 million per QALY. As-needed ranibizumab was dominated by monthly bevacizumab. In sensitivity analyses assuming a willingness to pay of $100,000 per QALY, the annual risk of serious vascular events would have to be at least 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 per QALY. In another sensitivity analysis, even if every patient receiving bevacizumab experienced declining vision by one category (eg, from 20/25-20/40 to 20/50-20/80) after 2 years but all patients receiving ranibizumab retained their vision level, as-needed ranibizumab would have an incremental cost-effectiveness ratio of $97,340 per QALY.

CONCLUSION

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.

Authors+Show Affiliations

Department of Ophthalmology and Visual Sciences (Dr Stein, Dr Newman-Casey, Dr Lee) and the Department of Health Management and Policy (Ms Mrinalini, Dr Hutton), University of Michigan, Ann Arbor.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24167325

Citation

Stein, Joshua D., et al. "Cost-effectiveness of Bevacizumab and Ranibizumab for Newly Diagnosed Neovascular Macular Degeneration (an American Ophthalmological Society Thesis)." Transactions of the American Ophthalmological Society, vol. 111, 2013, pp. 56-69.
Stein JD, Newman-Casey PA, Mrinalini T, et al. Cost-effectiveness of bevacizumab and ranibizumab for newly diagnosed neovascular macular degeneration (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc. 2013;111:56-69.
Stein, J. D., Newman-Casey, P. A., Mrinalini, T., Lee, P. P., & Hutton, D. W. (2013). Cost-effectiveness of bevacizumab and ranibizumab for newly diagnosed neovascular macular degeneration (an American Ophthalmological Society thesis). Transactions of the American Ophthalmological Society, 111, 56-69.
Stein JD, et al. Cost-effectiveness of Bevacizumab and Ranibizumab for Newly Diagnosed Neovascular Macular Degeneration (an American Ophthalmological Society Thesis). Trans Am Ophthalmol Soc. 2013;111:56-69. PubMed PMID: 24167325.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of bevacizumab and ranibizumab for newly diagnosed neovascular macular degeneration (an American Ophthalmological Society thesis). AU - Stein,Joshua D, AU - Newman-Casey,Paula Anne, AU - Mrinalini,Tavag, AU - Lee,Paul P, AU - Hutton,David W, PY - 2013/10/30/entrez PY - 2013/10/30/pubmed PY - 2014/3/19/medline SP - 56 EP - 69 JF - Transactions of the American Ophthalmological Society JO - Trans Am Ophthalmol Soc VL - 111 N2 - PURPOSE: 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. METHODS: Using a Markov 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 Schedules, and the medical literature. RESULTS: Compared with as-needed bevacizumab, the incremental cost-effectiveness ratio of monthly bevacizumab is $242,357 per quality-adjusted life year (QALY). Monthly ranibizumab gains an additional 0.02 QALYs vs monthly bevacizumab at an incremental cost-effectiveness ratio of more than $10 million per QALY. As-needed ranibizumab was dominated by monthly bevacizumab. In sensitivity analyses assuming a willingness to pay of $100,000 per QALY, the annual risk of serious vascular events would have to be at least 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 per QALY. In another sensitivity analysis, even if every patient receiving bevacizumab experienced declining vision by one category (eg, from 20/25-20/40 to 20/50-20/80) after 2 years but all patients receiving ranibizumab retained their vision level, as-needed ranibizumab would have an incremental cost-effectiveness ratio of $97,340 per QALY. CONCLUSION: 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. SN - 1545-6110 UR - https://www.unboundmedicine.com/medline/citation/24167325/Cost_effectiveness_of_bevacizumab_and_ranibizumab_for_newly_diagnosed_neovascular_macular_degeneration__an_American_Ophthalmological_Society_thesis__ L2 - https://aosonline.org/assets/xactions/2013/1545-6110_v111_p056.pdf DB - PRIME DP - Unbound Medicine ER -