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Chris Rogers, Helen Dakin, Sarah Wordsworth, Giselle Abangma, James Raftery, Simon Harding, Usha Chakravarthy, Andrew Lotery, Susan Downes, Barnaby Reeves, IVAN Study Investigators; Cost-effectiveness of ranibizumab and bevacizumab for neovascular age-related macular degeneration: 1 year IVAN results. Invest. Ophthalmol. Vis. Sci. 2013;54(15):373.
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To assess the incremental cost and cost-effectiveness of monthly and as-needed treatment regimens of bevacizumab (Avastin) and ranibizumab (Lucentis) for neovascular age-related macular degeneration (nAMD) from the perspective of the UK National Health Service.
In IVAN, a double-masked, factorial randomized controlled trial (ISRCTN92166560), 610 patients aged ≥50 years with untreated nAMD were randomized to ranibizumab or bevacizumab and to monthly or as-needed treatment. Quality of life (EQ-5D) and healthcare resource use (including: study medication; drug administration/monitoring consultations; and any concomitant medication, ambulatory consultations and hospitalizations linked to expected adverse events) were collected prospectively for all patients. We conducted a within-trial cost-utility analysis with a 1-year time horizon to assess the relative costs and cost-effectiveness of bevacizumab vs. ranibizumab and of as-needed vs. monthly treatment.
Total annual costs ranged from £9670 (95% CI: £9541, £9,799) per patient for monthly ranibizumab to £1504 (95% CI: £1433, £1575) for as-needed bevacizumab. Ranibizumab was significantly more costly than bevacizumab, costing an additional £7875 (95% CI: £7659, £8091; p<0.001) per patient for monthly treatment and £4993 (95% CI: £4556, £5430; p<0.001) for as-needed treatment. Preliminary results suggested that quality-adjusted life years (QALYs) varied between 0.817 (95% CI: 0.793, 0.840) for as-needed bevacizumab to 0.829 (95% CI: 0.805, 0.852) for as-needed ranibizumab, with no significant differences between drugs or dosing regimens (p>0.4). Bootstrapping analyses showed that if society is willing to pay £20,000 to gain a QALY, there is a 66% chance that as-needed bevacizumab is the most cost-effective treatment evaluated in IVAN and a 34% chance that monthly bevacizumab is best. The probability of either ranibizumab regimen being cost-effective was <0.01% at £20,000 and £30,000 (~$50,000) per QALY. Costs and QALYs allowing for expected and unexpected serious adverse events will also be presented.
The analysis, which included all treatment-related healthcare costs, demonstrates that we can be confident that ranibizumab is not cost-effective compared with bevacizumab, being substantially more costly and producing little or no additional health improvement.
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