June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Cost-effectiveness of FDA-approved anti-VEGF treatments, ranibizumab and aflibercept, for diabetic macular edema from a US perspective: analysis of 2-Year Protocol T comparative effectiveness results
Author Affiliations & Notes
  • Steve Duff
    Veritas Health Economics Consulting, Inc., Carlsbad, California, United States
  • Nancy Holekamp
    Pepose Vision Institute, Chesterfield, Missouri, United States
  • Yamina Rajput
    Genentech, Inc., South San Francisco, California, United States
  • Footnotes
    Commercial Relationships   Steve Duff, Genentech, Inc. (C); Nancy Holekamp, Genentech, Inc. (C); Yamina Rajput, Genentech, Inc. (E)
  • Footnotes
    Support  Genentech, Inc., South San Francisco, CA, provided support for the study and participated in the study design; conducting the study; and data collection, management, and interpretation.
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 5070. doi:
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      Steve Duff, Nancy Holekamp, Yamina Rajput; Cost-effectiveness of FDA-approved anti-VEGF treatments, ranibizumab and aflibercept, for diabetic macular edema from a US perspective: analysis of 2-Year Protocol T comparative effectiveness results. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5070.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Evaluate the relative differences in the costs and quality-adjusted life years (QALYs) of the two approved anti–vascular endothelial growth factor (VEGF) therapies, aflibercept and ranibizumab, using the 2-year Protocol T comparative effectiveness results for patients with DME.

Methods : A decision analytic model was developed based on 2-year visual acuity (VA) data, as well as treatment data, from the DRCR.net Protocol T study. Costs of aflibercept (2.0 mg) or ranibizumab (0.3 mg) treatment, VA-related medical costs, and health-related quality of life were simulated based on 8 VA health states. Costs (USD, 2016) of treatment, adverse event management, and VA-related resources were based on Medicare reimbursement and literature. VA-related health utilities were determined using a published algorithm. Analyses were conducted for VA subgroups (20/40 or better and 20/50 or worse) and the full cohort.

Results : Total 2-year costs for aflibercept vs. ranibizumab were $40,854 vs. $31,897, $48,214 vs. $37,246 and $44,423 vs. $34,529 in the better VA subgroup, worse VA subgroup, and the full cohort, respectively. QALYs for aflibercept vs. ranibizumab were 1.517 vs. 1.519, 1.433 vs. 1.412, and 1.476 vs. 1.466 in the better VA subgroup, worse VA subgroup, and the full cohort, respectively. In the better VA subgroup, an incremental cost-effectiveness ratio (ICER) was not calculated because ranibizumab, being less costly and equally effective, was dominant over aflibercept. The ICERs for aflibercept in the worse VA subgroup and the full cohort were $523,377 and $986,159 (per QALY gained), respectively, when compared to ranibizumab, and decrease to $250,135 and $720,846 when outcomes and costs are extrapolated to 10 years. These ICERs, regardless of time horizon, exceed conventional thresholds for recommended product adoption.

Conclusions : Aflibercept is not cost effective compared with ranibizumab for all patients regardless of baseline vision, based on this health economic analysis of Protocol T 2-year data using a comparison of FDA-approved anti-VEGF treatments for DME. The ICER for aflibercept is greater than the conventional threshold of $150,000 in the US. Aflibercept is more costly than ranibizumab with similar QALYs.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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