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Freekje Van Asten, Charlotte Michels, Carel C B Hoyng, Gert Jan van der Wilt, B. Jeroen Klevering, Maroeska M. Rovers, Janneke P.C. Grutters; No excuses. Bevacizumab should be first choice in AMD.. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3331. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Bevacizumab is an effective, safe and cheap treatment option for neovascular age-related macular degeneration (AMD). However, bevacizumab is not registered for AMD. Therefore, in some countries ophthalmologists either voluntarily choose or are forced to use the equally effective but expensive drugs ranibizumab and aflibercept. Here we describe the economic consequences of this dilemma surrounding AMD treatment.
We modelled cost-effectiveness of treatment with ranibizumab (as-needed), aflibercept (bimonthly) and bevacizumab (as-needed). The drug with the most favourable cost-effectiveness profile compared to bevacizumab was used for threshold analyses. First, we determined how much we overpay per injection. Second, we calculated the required effectiveness to justify the current price and what a reasonable price is for a drug that leads to optimal vision. Finally, we estimated how much we overspend on health care when bevacizumab is not first choice.
Bevacizumab treatment costs €27,087 ($28,799) per year, approximately €4,000 ($4,250) cheaper than aflibercept and €6,000 ($6,400) cheaper than ranibizumab. With similar effectiveness for all drugs, bevacizumab was clearly the most cost-effective. Aflibercept was chosen for threshold analyses. Aflibercept costs €943 ($1,003) per injection, but we determined that the acceptable price is actually €533 ($567). Alternatively, at its current price, aflibercept should yield about twice the visual gain. Even when optimal vision can be achieved, the maximum price for any treatment is €37,453 ($39,820) per year. Most importantly, Europe wastes €820 million and the US wastes $570 million on AMD treatment when choosing aflibercept over bevacizumab.
Bevacizumab is undoubtedly the most cost-effective treatment for AMD, yet it is not the standard of care across Europe and the US. The registered drugs ranibizumab and aflibercept cause huge overspending without additional health benefits. Health authorities should take steps to implement bevacizumab into clinical practice as first choice.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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