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Alan F Cruess, Mark Jeddi, Ron Goeree, Gord Blackhouse, Marianne Eriksson; Incremental Cost-Utility Ratio of Intravitreal Aflibercept Compared with Ranibizumab for the Treatment of Macular Edema Secondary to Central Retinal Vein Occlusion. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6089. doi: https://doi.org/.
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An economic evaluation was conducted to determine the incremental cost-utility ratio of intravitreal aflibercept compared with ranibizumab for the treatment of macular edema (ME) secondary to central retinal vein occlusion (CRVO) over a lifetime horizon from the perspective of a Canadian publicly funded healthcare system.
The Markov model consisted of six health states based on the Early Treatment of Diabetic Retinopathy Study chart: no vision impairment (≥80 letters); mild vision impairment (79-65 letters); moderate vision impairment (64-50 letters); severe vision impairment (49-35 letters); total blindness (best corrected visual acuity counting fingers or worse); and death. Transitions between health states were captured in a transition probability matrix reflecting the proportions of patients moving between each health state according to the COPERNICUS and CRUISE trial data. Three different time periods were modeled: monthly treatment (0-24 weeks), PRN treatment (24-52 weeks) and long-term disease progression (52 weeks onwards). Direct medical costs for the visual acuity health states were based on data from a 2008 multi-country survey of patients with visual impairment. Costs and outcomes occurring after 12 months were discounted at a rate of 5% per annum.
Deterministic analyses show that treatment with intravitreal aflibercept provides 7.33 quality-adjusted life years (QALYs) at a cost of CDN$89,377 while treatment with ranibizumab resulted in 7.08 QALYs at a cost of CDN$95,006. The majority of 1,000 probabilistic modeling simulations indicate that treatment with intravitreal aflibercept is effective and less costly than ranibizumab. Cost-effectiveness acceptability curves demonstrated that the probability of intravitreal aflibercept being cost-effective at any willingness-to-pay threshold between CDN$0 and CDN$100,000 is greater than 90%. All sensitivity analyses reveal that intravitreal aflibercept dominated ranibizumab.
Intravitreal aflibercept is an effective and well tolerated option for the treatment of ME secondary to CRVO, and is cost-effective compared with ranibizumab.
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