June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Cost-effectiveness of ranibizumab and bevacizumab for neovascular age-related macular degeneration: 1 year IVAN results
Author Affiliations & Notes
  • Chris Rogers
    Clinical Trials & Evaluation Unit, University of Bristol, Bristol, United Kingdom
  • Helen Dakin
    Health Economics Research Centre, Department of Public Health, University of Oxford, Oxford, United Kingdom
  • Sarah Wordsworth
    Health Economics Research Centre, Department of Public Health, University of Oxford, Oxford, United Kingdom
  • Giselle Abangma
    Health Economics Research Centre, Department of Public Health, University of Oxford, Oxford, United Kingdom
  • James Raftery
    Wessex Institute for Health Research and Development, University of Southampton, Southampton, United Kingdom
  • Simon Harding
    Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
  • Usha Chakravarthy
    Institute of Clinical Science, The Queen’s University of Belfast, Belfast, United Kingdom
  • Andrew Lotery
    Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
  • Susan Downes
    Oxford University Hospitals NHS Trust, Oxford, United Kingdom
  • Barnaby Reeves
    Clinical Trials & Evaluation Unit, University of Bristol, Bristol, United Kingdom
  • Footnotes
    Commercial Relationships Chris Rogers, Novartis (R); Helen Dakin, Pfizer (in different diseases - not AMD) (C), Pfizer (in different diseases - not AMD) (F); Sarah Wordsworth, None; Giselle Abangma, None; James Raftery, None; Simon Harding, Novartis (F), Novartis (R); Usha Chakravarthy, Bayer (C), Novartis (F), Neovista (C), Oraya (F); Andrew Lotery, Novartis (F), Bayer (R); Susan Downes, Novartis (F), Novartis (R); Barnaby Reeves, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 373. doi:
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      Chris Rogers, Helen Dakin, Sarah Wordsworth, Giselle Abangma, James Raftery, Simon Harding, Usha Chakravarthy, Andrew Lotery, Susan Downes, Barnaby Reeves, ; 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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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: 412 age-related macular degeneration • 460 clinical (human) or epidemiologic studies: health care delivery/economics/manpower • 466 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials  
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