Cost-effectiveness of ranibizumab versus aflibercept in the treatment of visual impairment due to diabetic macular edema: a UK healthcare perspective

Abstract

BackgroundRanibizumab and aflibercept are alternative anti-vascular endothelial growth factor agents approved for the treatment of visual impairment (VI) due to diabetic macular edema (DME).ObjectiveTo estimate, from a UK healthcare perspective, the cost-effectiveness of ranibizumab 0.5 mg pro re nata (PRN) and ranibizumab 0.5 mg treat and extend (T&E) compared with aflibercept 2 mg every 8 weeks after five initial monthly doses (2q8) in the treatment of VI due to DME.MethodsA Markov model previously reviewed by the National Institute for Health and Care Excellence was used to simulate the long-term outcomes and costs of treating DME. Health states were defined by increments of ten letters in best-corrected visual acuity (BCVA), with a 3-month cycle length. Patients could gain (or lose) a maximum of two health states between cycles. A 3-year treatment time frame and a lifetime horizon were used. Future costs and health outcomes were discounted at 3.5% per annum. Patient baseline characteristics and the efficacy of ranibizumab PRN were derived using data from the RESTORE study. The relative efficacies of ranibizumab PRN, ranibizumab T&E, and aflibercept were assessed with a network meta-analysis. Different utilities were assigned based on BCVA and whether the treated eye was the better- or the worse-seeing eye. Sensitivity analyses tested the robustness of the model.ResultsLifetime costs per patient of treating DME were £20,019 for ranibizumab PRN, £22,930 for ranibizumab T&E, and £25,859 for aflibercept 2q8. Ranibizumab was dominant over aflibercept, with an incremental gain of 0.05 quality-adjusted life-years (QALYs) and cost savings of £5,841 (PRN) and £2,930 (T&E) compared with aflibercept. Ranibizumab PRN and ranibizumab T&E had 79% and 67% probability, respectively, of being cost-effective relative to aflibercept at a willingness-to-pay threshold of £20,000/QALY. When assuming the higher end of PRN injection frequency (15.9 over 3 years), the cost savings associated with ranibizumab were £3,969.ConclusionFrom a UK healthcare perspective, ranibizumab provides greater health gains with lower overall costs than aflibercept in patients with VI due to DME.

Diabetic macular edema, innovative technologies and economic impact: New opportunities for the Lombardy Region healthcare system?

“…The results of the presented economic analysis undertaken in the Italian setting are consistent with those published in the other European Countries (UK and Greece), from a healthcare decision maker's perspective, for the treatment of patients with DME (Regnier et al. ; Kourlaba et al. ; Romero‐Aroca et al.…”

“…The analysis demonstrated that in a clinical setting characterised by the potential administration of all the three options licensed for the treatment of DME currently available, it emerged that: (i) treating a larger proportion of eligible patients with Dexamethasone implant would significantly reduce the healthcare expenditure, and/or free up resources to treat more patients; (ii) the preferable scenario for the regional healthcare service is that which supports patient access to a broad range of alternative technologies as first-choice treatment, which also coincides with maximising clinician choice; (iii) from the comparison between real life and clinical trial retreatment rates, a significant initial investment (within the 12-24 month-time window) would be required, even if could be amply rewarded in the long run (reporting on average the highest value of cost saving in the third year); (iv) the additional investments required to guarantee the retreatment rates used in the clinical trials could be mitigated by applying a higher market share of Dexamethasone, and (v) the inclusion of Aflibercept, both in second-line and in first-line treatment, resulted in a minimal economic impact for the healthcare service. The results of the presented economic analysis undertaken in the Italian setting are consistent with those published in the other European Countries (UK and Greece), from a healthcare decision maker's perspective, for the treatment of patients with DME (Regnier et al 2015;Kourlaba et al 2016;Romero-Aroca et al 2016). The economic savings resulting from the adoption of Dexamethasone could be reinvested within the same therapeutic area, thus (i) improving patient access and adherence to therapy, (ii) treating a wider population and (iii) reducing waiting lists.…”

Cost-Effectiveness of Ranibizumab Versus Aflibercept for Macular Edema Secondary to Branch Retinal Vein Occlusion: A UK Healthcare Perspective

“…Utility values for each health state were assigned based on BCVA and whether the treated eye was the BSE or WSE. Utility values for the BSE health states were obtained from a recent cost-effectiveness evaluation in diabetic macular edema (DME) [ 19 ]: the values, which were calculated using data from Czoski-Murray et al [ 20 ], ranged from 0.850 for the best possible state to 0.353 for the worst possible state. For the WSE, due to the absence of appropriate data, it was assumed that patients could experience a maximum gain of 0.1 utility between the best and worst states (compared with 0.52 in the BSE).…”

“…Drug prices for ranibizumab and aflibercept were obtained from the British National Formulary [ 23 , 24 ]. The costs of treatment visits and monitoring visits were derived from a previous analysis [ 19 ] and were updated to 2014 costs using the Hospital and Community Health Services inflation index [ 25 ]. The cost of blindness was associated with individuals whose BCVA was less than 35 letters (see Table S2 in the supplementary material).…”

Aflibercept in diabetic macular edema: evaluating efficacy as a primary and secondary therapeutic option

“…1,2,6,7 Patients treated with both drugs have shown excellent visual gains, long term stability and improved anatomy compared with grid laser treatment and steroid injections, making them the first line treatment for visual loss associated with DME. 2 A study by Regnier et al 8 showed that the lifetime cost of treating patients with DME in the UK was £20 019 for ranibizumab PRN and £25 859 for aflibercept using a bimonthly dosing regimen. It also demonstrated that from a UK healthcare perspective ranibizumab provides greater health gains with lower overall costs than aflibercept.…”