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The Cost-Effectiveness of Ranibizumab for the Treatment of Diabetic Macular Edema.
Ophthalmology. 2015 Jul; 122(7):1416-25.O

Abstract

PURPOSE

To assess the incremental, comparative effectiveness (patient value gain) and cost effectiveness (financial value gain) associated with 0.3-mg intravitreal ranibizumab injection therapy versus sham therapy for diabetic macular edema (DME).

DESIGN

Value-Based Medicine (Center for Value-Based Medicine, Flourtown, PA) 14-year, cost-utility analysis using patient preferences and 2012 United States real dollars.

PARTICIPANTS

Published data from the identical Ranibizumab Injection in Subjects with Clinically Significant Macular Edema with Center Involvement Secondary to Diabetes Mellitus (RISE and RIDE) clinical trials.

METHODS

An incremental cost-utility analysis was performed using societal and third-party insurer cost perspectives. Costs and outcomes were discounted with net present value analysis at 3% per annum.

MAIN OUTCOME MEASURES

The incremental comparative effectiveness was measured in: (1) quality-adjusted life year (QALY) gain and (2) percent patient value (quality-of-life) gain. Cost effectiveness was quantified with the cost-utility ratio (CUR) measured as $/QALY.

RESULTS

The 14-year, incremental patient value gain conferred by intravitreal ranibizumab therapy for diabetic maculopathy was 0.9981 QALY, equating to an 11.6% improvement in quality of life. The direct, ophthalmic medical cost for ranibizumab therapy in 1 eye was $30 116, whereas for 2 eyes it was $56 336. The direct, nonophthalmic, medical costs saved from decreased depression, injury, skilled nursing facility admissions, nursing home admissions, and other vision-associated costs totaled $51 758, resulting in an overall direct medical cost of $4578. The net mean societal cost for bilateral ranibizumab therapy was -$30 807. Of this total, decreased caregiver costs accrued a $31 406 savings against the direct medical costs, whereas decreased wage losses accrued a $3978 savings. The third-party insurer CUR for bilateral ranibizumab therapy was $4587/QALY. The societal cost perspective for bilateral therapy was -$30 807/QALY, indicating that ranibizumab therapy dominated sham therapy because it conferred both a positive QALY gain of 0.9981 and a financial value gain (positive financial return on investment) of $30 807 referent to the direct ophthalmic medical costs expended.

CONCLUSIONS

Intravitreal ranibizumab therapy for the treatment of DME confers considerable patient (human) value gain. It also accrues financial value to patients, public and private insurers, and society.

Authors+Show Affiliations

Center for Value-Based Medicine, Flourtown, Pennsylvania; Eye Research Institute, Philadelphia, Pennsylvania; Retina Service, Wills Eye Institute, Jefferson Medical College, Philadelphia, Pennsylvania. Electronic address: gbrown@valuebasedmedicine.com.Center for Value-Based Medicine, Flourtown, Pennsylvania; Eye Research Institute, Philadelphia, Pennsylvania; Research Department, Wills Eye Institute, Jefferson Medical College, Philadelphia, Pennsylvania.Healthcare Economics Unit, Genentech, Inc., South San Francisco, California.Healthcare Economics Unit, Genentech, Inc., South San Francisco, California.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25935787

Citation

Brown, Gary C., et al. "The Cost-Effectiveness of Ranibizumab for the Treatment of Diabetic Macular Edema." Ophthalmology, vol. 122, no. 7, 2015, pp. 1416-25.
Brown GC, Brown MM, Turpcu A, et al. The Cost-Effectiveness of Ranibizumab for the Treatment of Diabetic Macular Edema. Ophthalmology. 2015;122(7):1416-25.
Brown, G. C., Brown, M. M., Turpcu, A., & Rajput, Y. (2015). The Cost-Effectiveness of Ranibizumab for the Treatment of Diabetic Macular Edema. Ophthalmology, 122(7), 1416-25. https://doi.org/10.1016/j.ophtha.2015.03.032
Brown GC, et al. The Cost-Effectiveness of Ranibizumab for the Treatment of Diabetic Macular Edema. Ophthalmology. 2015;122(7):1416-25. PubMed PMID: 25935787.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Cost-Effectiveness of Ranibizumab for the Treatment of Diabetic Macular Edema. AU - Brown,Gary C, AU - Brown,Melissa M, AU - Turpcu,Adam, AU - Rajput,Yamina, Y1 - 2015/04/29/ PY - 2015/02/11/received PY - 2015/03/25/revised PY - 2015/03/28/accepted PY - 2015/5/4/entrez PY - 2015/5/4/pubmed PY - 2015/9/26/medline SP - 1416 EP - 25 JF - Ophthalmology JO - Ophthalmology VL - 122 IS - 7 N2 - PURPOSE: To assess the incremental, comparative effectiveness (patient value gain) and cost effectiveness (financial value gain) associated with 0.3-mg intravitreal ranibizumab injection therapy versus sham therapy for diabetic macular edema (DME). DESIGN: Value-Based Medicine (Center for Value-Based Medicine, Flourtown, PA) 14-year, cost-utility analysis using patient preferences and 2012 United States real dollars. PARTICIPANTS: Published data from the identical Ranibizumab Injection in Subjects with Clinically Significant Macular Edema with Center Involvement Secondary to Diabetes Mellitus (RISE and RIDE) clinical trials. METHODS: An incremental cost-utility analysis was performed using societal and third-party insurer cost perspectives. Costs and outcomes were discounted with net present value analysis at 3% per annum. MAIN OUTCOME MEASURES: The incremental comparative effectiveness was measured in: (1) quality-adjusted life year (QALY) gain and (2) percent patient value (quality-of-life) gain. Cost effectiveness was quantified with the cost-utility ratio (CUR) measured as $/QALY. RESULTS: The 14-year, incremental patient value gain conferred by intravitreal ranibizumab therapy for diabetic maculopathy was 0.9981 QALY, equating to an 11.6% improvement in quality of life. The direct, ophthalmic medical cost for ranibizumab therapy in 1 eye was $30 116, whereas for 2 eyes it was $56 336. The direct, nonophthalmic, medical costs saved from decreased depression, injury, skilled nursing facility admissions, nursing home admissions, and other vision-associated costs totaled $51 758, resulting in an overall direct medical cost of $4578. The net mean societal cost for bilateral ranibizumab therapy was -$30 807. Of this total, decreased caregiver costs accrued a $31 406 savings against the direct medical costs, whereas decreased wage losses accrued a $3978 savings. The third-party insurer CUR for bilateral ranibizumab therapy was $4587/QALY. The societal cost perspective for bilateral therapy was -$30 807/QALY, indicating that ranibizumab therapy dominated sham therapy because it conferred both a positive QALY gain of 0.9981 and a financial value gain (positive financial return on investment) of $30 807 referent to the direct ophthalmic medical costs expended. CONCLUSIONS: Intravitreal ranibizumab therapy for the treatment of DME confers considerable patient (human) value gain. It also accrues financial value to patients, public and private insurers, and society. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/25935787/The_Cost_Effectiveness_of_Ranibizumab_for_the_Treatment_of_Diabetic_Macular_Edema_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(15)00316-4 DB - PRIME DP - Unbound Medicine ER -