Cost-effectiveness of ranibizumab and bevacizumab for age-related macular degeneration: 2-year findings from the IVAN randomised trial
Cost-effectiveness of ranibizumab and bevacizumab for age-related macular degeneration: 2-year findings from the IVAN randomised trial
Objective: To assess the incremental cost and cost-effectiveness of continuous and discontinuous regimens of bevacizumab (Avastin) and ranibizumab (Lucentis) for neovascular age-related macular degeneration (nAMD) from a UK National Health Service (NHS) perspective.
Design: A within-trial cost-utility analysis with a 2-year time horizon, based on a multicentre factorial, non-inferiority randomised controlled trial.
Setting: 23 hospital ophthalmology clinics.
Participants: 610 patients aged ?50?years with untreated nAMD in the study eye.
Interventions: 0.5?mg ranibizumab or 1.25?mg bevacizumab given continuously (monthly) or discontinuously (as-needed) for 2?years.
Main Outcome Measures: Quality-adjusted life-years (QALYs).
Results: Total 2-year costs ranged from £3002/patient ($4700; 95% CI £2601 to £3403) for discontinuous bevacizumab to £18?590/patient ($29?106; 95% CI £18?258 to £18?922) for continuous ranibizumab. Ranibizumab was significantly more costly than bevacizumab for both continuous (+£14?989/patient ($23?468); 95% CI £14?522 to £15?456; p<0.001) and discontinuous treatment (+£8498 ($13?305); 95% CI £7700 to £9295; p<0.001), with negligible difference in QALYs. Continuous ranibizumab would only be cost-effective compared with continuous bevacizumab if the NHS were willing to pay £3.5 million ($5.5 million) per additional QALY gained. Patients receiving continuous bevacizumab accrued higher total costs (+£599 ($938); 95% CI £91 to £1107; p=0.021) than those receiving discontinuous bevacizumab, but also accrued non-significantly more QALYs (+0.020; 95% CI -0.032 to 0.071; p=0.452). Continuous bevacizumab therefore cost £30?220 ($47?316) per QALY gained versus discontinuous bevacizumab. However, bootstrapping demonstrated that if the NHS is willing to pay £20?000/QALY gained, there is a 37% chance that continuous bevacizumab is cost-effective versus discontinuous bevacizumab.
Conclustions: Ranibizumab is not cost-effective compared with bevacizumab, being substantially more costly and producing little or no QALY gain. Discontinuous bevacizumab is likely to be the most cost-effective of the four treatment strategies evaluated in this UK trial, although there is a 37% chance that continuous bevacizumab is cost-effective.
neovascular age-related macular degeneration (AMD, cost-effectiveness, cost-minimisation analysis, cost-utility analysis, trial-based economic evaluation, vascular endothelial growth factor (VEGF) inhibitors
1-11
Dakin, H.A.
2c59f161-894e-4fc0-baaa-b130920b3408
Wordsworth, S.
d5991e11-402f-43a3-94f7-0ce0133e2c5b
Rogers, C.A.
b0965cd9-8b20-44cd-8062-3ef6eff2c0f6
Abangma, G.
61ca0cbf-7958-443a-a7af-9605ecf87c47
Raftery, J.
27c2661d-6c4f-448a-bf36-9a89ec72bd6b
Harding, S.P.
43c50ad7-4242-493e-895f-c520648621d9
Lotery, A.J.
5ecc2d2d-d0b4-468f-ad2c-df7156f8e514
Downes, S.M.
1b7234c6-9e72-42d7-8a7c-e6b37110f586
Chakravarthy, U.
98345bdd-d823-4aad-b205-0045413574d7
Reeves, B.C.
866ee67e-2615-4fe4-962c-33da6dda1163
29 July 2014
Dakin, H.A.
2c59f161-894e-4fc0-baaa-b130920b3408
Wordsworth, S.
d5991e11-402f-43a3-94f7-0ce0133e2c5b
Rogers, C.A.
b0965cd9-8b20-44cd-8062-3ef6eff2c0f6
Abangma, G.
61ca0cbf-7958-443a-a7af-9605ecf87c47
Raftery, J.
27c2661d-6c4f-448a-bf36-9a89ec72bd6b
Harding, S.P.
43c50ad7-4242-493e-895f-c520648621d9
Lotery, A.J.
5ecc2d2d-d0b4-468f-ad2c-df7156f8e514
Downes, S.M.
1b7234c6-9e72-42d7-8a7c-e6b37110f586
Chakravarthy, U.
98345bdd-d823-4aad-b205-0045413574d7
Reeves, B.C.
866ee67e-2615-4fe4-962c-33da6dda1163
Dakin, H.A., Wordsworth, S., Rogers, C.A., Abangma, G., Raftery, J., Harding, S.P., Lotery, A.J., Downes, S.M., Chakravarthy, U. and Reeves, B.C.
(2014)
Cost-effectiveness of ranibizumab and bevacizumab for age-related macular degeneration: 2-year findings from the IVAN randomised trial.
British Medical Journal, 4 (7), .
(doi:10.1136/bmjopen-2014-005094).
(PMID:25079928)
Abstract
Objective: To assess the incremental cost and cost-effectiveness of continuous and discontinuous regimens of bevacizumab (Avastin) and ranibizumab (Lucentis) for neovascular age-related macular degeneration (nAMD) from a UK National Health Service (NHS) perspective.
Design: A within-trial cost-utility analysis with a 2-year time horizon, based on a multicentre factorial, non-inferiority randomised controlled trial.
Setting: 23 hospital ophthalmology clinics.
Participants: 610 patients aged ?50?years with untreated nAMD in the study eye.
Interventions: 0.5?mg ranibizumab or 1.25?mg bevacizumab given continuously (monthly) or discontinuously (as-needed) for 2?years.
Main Outcome Measures: Quality-adjusted life-years (QALYs).
Results: Total 2-year costs ranged from £3002/patient ($4700; 95% CI £2601 to £3403) for discontinuous bevacizumab to £18?590/patient ($29?106; 95% CI £18?258 to £18?922) for continuous ranibizumab. Ranibizumab was significantly more costly than bevacizumab for both continuous (+£14?989/patient ($23?468); 95% CI £14?522 to £15?456; p<0.001) and discontinuous treatment (+£8498 ($13?305); 95% CI £7700 to £9295; p<0.001), with negligible difference in QALYs. Continuous ranibizumab would only be cost-effective compared with continuous bevacizumab if the NHS were willing to pay £3.5 million ($5.5 million) per additional QALY gained. Patients receiving continuous bevacizumab accrued higher total costs (+£599 ($938); 95% CI £91 to £1107; p=0.021) than those receiving discontinuous bevacizumab, but also accrued non-significantly more QALYs (+0.020; 95% CI -0.032 to 0.071; p=0.452). Continuous bevacizumab therefore cost £30?220 ($47?316) per QALY gained versus discontinuous bevacizumab. However, bootstrapping demonstrated that if the NHS is willing to pay £20?000/QALY gained, there is a 37% chance that continuous bevacizumab is cost-effective versus discontinuous bevacizumab.
Conclustions: Ranibizumab is not cost-effective compared with bevacizumab, being substantially more costly and producing little or no QALY gain. Discontinuous bevacizumab is likely to be the most cost-effective of the four treatment strategies evaluated in this UK trial, although there is a 37% chance that continuous bevacizumab is cost-effective.
Text
__userfiles.soton.ac.uk_Users_slb1_mydocuments_e005094.full.pdf
- Other
Available under License Other.
More information
Published date: 29 July 2014
Keywords:
neovascular age-related macular degeneration (AMD, cost-effectiveness, cost-minimisation analysis, cost-utility analysis, trial-based economic evaluation, vascular endothelial growth factor (VEGF) inhibitors
Organisations:
Clinical & Experimental Sciences
Identifiers
Local EPrints ID: 367801
URI: http://eprints.soton.ac.uk/id/eprint/367801
ISSN: 0959-8138
PURE UUID: 5e082265-a271-4c63-b2b5-a6b76218069b
Catalogue record
Date deposited: 18 Aug 2014 09:30
Last modified: 15 Mar 2024 03:16
Export record
Altmetrics
Contributors
Author:
H.A. Dakin
Author:
S. Wordsworth
Author:
C.A. Rogers
Author:
G. Abangma
Author:
S.P. Harding
Author:
S.M. Downes
Author:
U. Chakravarthy
Author:
B.C. Reeves
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics