Cost-effectiveness of Intravitreous Ranibizumab Compared With Panretinal Photocoagulation for Proliferative Diabetic Retinopathy

Abstract

clinical trial results suggest that ranibizumab is a reasonable treatment alternative to panretinal photocoagulation (PRP) when managing proliferative diabetic retinopathy (PDR), with or without concomitant baseline diabetic macular edema (DME). However, ranibizumab injections are costly. Thus, it would be useful to examine the relative cost-effectiveness of these 2 treatment modalities. OBJECTIVE To evaluate incremental cost-effectiveness ratios of 0.5-mg ranibizumab therapy vs PRP for PDR. DESIGN, SETTING, AND PARTICIPANTS Preplanned secondary analysis using efficacy, safety, and resource utilization data through 2 years of follow-up at 55 US sites for 213 adults with PDR. Data were collected from February 2012 to January 2015. INTERVENTIONS Intravitreous 0.5-mg ranibizumab at baseline and as frequently as every 4 weeks based on a structured retreatment protocol or PRP at baseline for PDR. Eyes in both groups could receive ranibizumab for concomitant DME. MAIN OUTCOMES AND MEASURES Incremental cost-effectiveness ratios of ranibizumab compared with PRP evaluated within 2 prespecified subgroups for the study eye: with baseline vision-impairing (Snellen equivalent 20/32 or worse) DME and without baseline vision-impairing DME. RESULTS The study included 305 adults with PDR, the mean age was 52 years, 44% were women, and 52% were white. Of the 46 participants with PDR and vision-impairing DME at baseline, 21 were assigned to the ranibizumab group and 25 to the PRP group (plus ranibizumab for DME). Among the remaining participants without baseline vision-impairing DME, 80 and 87 were in the ranibizumab and PRP groups, respectively.

Region‐specific ischemia, neovascularization and macular oedema in treatment‐naïve proliferative diabetic retinopathy

“…This zone-specific phenomenon is supported by a significant correlation between NPIfpz and NVImpz (Fig. 19 Based on our findings, if the ischemia is responsible for the neovascularization at the neighbouring zone, a FA-guided, region-targeted PRP at ischemic retina may be proposed as the first attempt in early and moderate PDR. 18 However, this rule cannot be simply applied to all perfused/non-perfused neighbouring zones in the retina.…”

“…Although Protocol S suggests anti-VEGF treatment as an effective alternative of pan-retinal photocoagulation (PRP), PRP is still the mainstay of treatment for PDR. 19 Based on our findings, if the ischemia is responsible for the neovascularization at the neighbouring zone, a FA-guided, region-targeted PRP at ischemic retina may be proposed as the first attempt in early and moderate PDR.…”

Intravitreal aflibercept compared with panretinal photocoagulation for proliferative diabetic retinopathy: the CLARITY non-inferiority RCT

“…This study used a 12-month recall period for contacts with health and social care services, which is considered reasonable but towards the boundary of recall for patients. 88 For the economic evaluation, we were primarily interested in our health economic analysis on how the cost per change in BCVA compared with the cost per QALY and hence decided to use complete-case analysis where full data were available for these outcome measures. We do not impute costs and, therefore, this left us with 202 participants (this represents 96.7% of the clinical sample included in primary outcome ITT analysis).…”

Comparison of 577-nm Multispot and Standard Single-Spot Photocoagulation for Diabetic Retinopathy

“…Considering the classic studies [1, 2] and recent cost-effectiveness studies [5, 6], PRP remains the standard cost-effective treatment of choice for PDR, reducing the risk of severe visual loss over the long term by 50% [1]. New laser techniques have recently emerged [9, 18, 19] to decrease the side effects associated with PRP.…”

“…Therefore, those studies concluded that repeated anti-VEGF injections were not inferior and even superior in the CLARITY study to PRP for treating PDR. However, cost-effectiveness studies [5, 6] have reported that intravitreal ranibizumab as monotherapy for PDR incurred an estimated cost of USD 22,576 compared with USD 7,445 for those treated with PRP for only 2 years, among other calculations that concluded that ranibizumab was a non-cost-effective treatment. This is even more critical when assuming the necessity for life-long treatment [6].…”