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Peter A Karth, Darius M. Moshfeghi, Mark S Blumenkranz; Cost and Utility Analysis of Treatments for Macular Edema in Central Retinal Vein Occlusion. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2143.
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© ARVO (1962-2015); The Authors (2016-present)
To present analysis of the relative costs of intravitreal aflibercept, ranibizumab, bevacizumab, dexamethasone implant and triamcinolone for treatment of macular edema due to central retinal vein occlusion (CRVO), correlate the costs of gains in visual acuity, and determine the utility of those gains.
Data from relevant randomized clinical trials were analyzed. Visual acuity results and treatment protocols were obtained from several large published clinical trials focused on macular edema due to CRVO treated with the above agents versus natural history. The cost of one year of treatment was calculated with the trial protocols and a more clinically relevant modified protocol. The utility of the visual improvement was determined, including area-under-the-curve analysis. The cost for the gain in visual acuity and the increase in utility was calculated, resulting in quality-adjusted life year (QALY) outcomes for each medication.
In all scenarios presented, bevacizumab provided the most economical treatment of macular edema due to CRVO by a large margin (as much as 84%). Intravitreal triamcinolone proved to be the next most economical, however this treatment offered the lowest total utility improvement. Aflibercept, ranibizumab, and dexamethasone implant provided similar cost per utility unit gained, however dexamethasone implant provided the least total utility improvement of these three and highest cost per QALY (up to $28,844, adjusted). Within the anti-vascular endothelial growth factor class, which provided similar and significant utility gains, cost savings between the most expensive (ranibizumab; $20,640) and the least expensive (bevacizumab; $3,298) medication was as much as an 84%, adjusted for utility yields. Medication costs alone range from less than 1% to 78.6% of total treatment cost.
Now that clinical trial is available on a number of different treatment strategies for macular edema due to CRVO with similar treatment criteria, it is possible to perform an analysis of costs and benefits, including utility gained by patients, of each modality that can then be used when assessing treatment option. In our analysis, bevacizumab offers significant cost-utility and QALY advantages over other treatments.
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