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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
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
0959-8138
1-11
Dakin, H.A.
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Wordsworth, S.
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Rogers, C.A.
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Abangma, G.
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Raftery, J.
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Harding, S.P.
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Lotery, A.J.
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Downes, S.M.
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Chakravarthy, U.
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Reeves, B.C.
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Dakin, H.A.
2c59f161-894e-4fc0-baaa-b130920b3408
Wordsworth, S.
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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.
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Downes, S.M.
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Chakravarthy, U.
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Reeves, B.C.
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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), 1-11. (doi:10.1136/bmjopen-2014-005094). (PMID:25079928)

Record type: Article

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.

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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: https://eprints.soton.ac.uk/id/eprint/367801
ISSN: 0959-8138
PURE UUID: 5e082265-a271-4c63-b2b5-a6b76218069b
ORCID for A.J. Lotery: ORCID iD orcid.org/0000-0001-5541-4305

Catalogue record

Date deposited: 18 Aug 2014 09:30
Last modified: 10 Sep 2019 00:46

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