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Cost effectiveness of Ranibizumab vs Aflibercept vs Bevacizumab for the treatment of macular oedema due to central retinal vein occlusion: The LEAVO Study

Cost effectiveness of Ranibizumab vs Aflibercept vs Bevacizumab for the treatment of macular oedema due to central retinal vein occlusion: The LEAVO Study
Cost effectiveness of Ranibizumab vs Aflibercept vs Bevacizumab for the treatment of macular oedema due to central retinal vein occlusion: The LEAVO Study

Background: We aimed to assess the cost effectiveness of intravitreal ranibizumab (Lucentis), aflibercept (Eylea) and bevacizumab (Avastin) for the treatment of macular oedema due to central retinal vein occlusion. Methods: We calculated costs and quality-adjusted life-years from the UK National Health Service and Personal Social Services perspective. We performed a within-trial analysis using the efficacy, safety, resource use and health utility data from a randomised controlled trial (LEAVO) over 100 weeks. We built a discrete event simulation to model long-term outcomes. We estimated utilities using the Visual-Functioning Questionnaire-Utility Index, EQ-5D and EQ-5D with an additional vision question. We used standard UK costs sources for 2018/19 and a cost of £28 per bevacizumab injection. We discounted costs and quality-adjusted life-years at 3.5% annually. Results: Bevacizumab was the least costly intervention followed by ranibizumab and aflibercept in both the within-trial analysis (bevacizumab: £6292, ranibizumab: £13,014, aflibercept: £14,328) and long-term model (bevacizumab: £18,353, ranibizumab: £30,226, aflibercept: £35,026). Although LEAVO did not demonstrate bevacizumab to be non-inferior for the visual acuity primary outcome, the three interventions generated similar quality-adjusted life-years in both analyses. Bevacizumab was always the most cost-effective intervention at a threshold of £30,000 per quality-adjusted life-year, even using the list price of £243 per injection. Conclusions: Wider adoption of bevacizumab for the treatment of macular oedema due to central retinal vein occlusion could result in substantial savings to healthcare systems and deliver similar health-related quality of life. However, patients, funders and ophthalmologists should be fully aware that LEAVO could not demonstrate that bevacizumab is non-inferior to the licensed agents.

1170-7690
913-927
Pennington, Becky
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Alshreef, Abualbishr
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Flight, Laura
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Metry, Andrew
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Poku, Edith
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Hykin, Philip
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Sivaprasad, Sobha
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Prevost, A. Toby
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Vasconcelos, Joana C.
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Murphy, Caroline
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Kelly, Joanna
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Yang, Yit
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Lotery, Andrew
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Williams, Michael
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Brazier, John
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Pennington, Becky
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Alshreef, Abualbishr
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Flight, Laura
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Metry, Andrew
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Poku, Edith
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Hykin, Philip
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Sivaprasad, Sobha
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Prevost, A. Toby
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Vasconcelos, Joana C.
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Murphy, Caroline
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Kelly, Joanna
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Yang, Yit
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Lotery, Andrew
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Williams, Michael
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Brazier, John
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Pennington, Becky, Alshreef, Abualbishr, Flight, Laura, Metry, Andrew, Poku, Edith, Hykin, Philip, Sivaprasad, Sobha, Prevost, A. Toby, Vasconcelos, Joana C., Murphy, Caroline, Kelly, Joanna, Yang, Yit, Lotery, Andrew, Williams, Michael and Brazier, John (2021) Cost effectiveness of Ranibizumab vs Aflibercept vs Bevacizumab for the treatment of macular oedema due to central retinal vein occlusion: The LEAVO Study. PharmacoEconomics, 39 (8), 913-927. (doi:10.1007/s40273-021-01026-5).

Record type: Article

Abstract

Background: We aimed to assess the cost effectiveness of intravitreal ranibizumab (Lucentis), aflibercept (Eylea) and bevacizumab (Avastin) for the treatment of macular oedema due to central retinal vein occlusion. Methods: We calculated costs and quality-adjusted life-years from the UK National Health Service and Personal Social Services perspective. We performed a within-trial analysis using the efficacy, safety, resource use and health utility data from a randomised controlled trial (LEAVO) over 100 weeks. We built a discrete event simulation to model long-term outcomes. We estimated utilities using the Visual-Functioning Questionnaire-Utility Index, EQ-5D and EQ-5D with an additional vision question. We used standard UK costs sources for 2018/19 and a cost of £28 per bevacizumab injection. We discounted costs and quality-adjusted life-years at 3.5% annually. Results: Bevacizumab was the least costly intervention followed by ranibizumab and aflibercept in both the within-trial analysis (bevacizumab: £6292, ranibizumab: £13,014, aflibercept: £14,328) and long-term model (bevacizumab: £18,353, ranibizumab: £30,226, aflibercept: £35,026). Although LEAVO did not demonstrate bevacizumab to be non-inferior for the visual acuity primary outcome, the three interventions generated similar quality-adjusted life-years in both analyses. Bevacizumab was always the most cost-effective intervention at a threshold of £30,000 per quality-adjusted life-year, even using the list price of £243 per injection. Conclusions: Wider adoption of bevacizumab for the treatment of macular oedema due to central retinal vein occlusion could result in substantial savings to healthcare systems and deliver similar health-related quality of life. However, patients, funders and ophthalmologists should be fully aware that LEAVO could not demonstrate that bevacizumab is non-inferior to the licensed agents.

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More information

Accepted/In Press date: 30 March 2021
Published date: 26 April 2021

Identifiers

Local EPrints ID: 451163
URI: http://eprints.soton.ac.uk/id/eprint/451163
ISSN: 1170-7690
PURE UUID: 90b24118-580d-46d4-855f-7cde6c788807
ORCID for Andrew Lotery: ORCID iD orcid.org/0000-0001-5541-4305

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Date deposited: 14 Sep 2021 15:31
Last modified: 26 Nov 2021 02:47

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Contributors

Author: Becky Pennington
Author: Abualbishr Alshreef
Author: Laura Flight
Author: Andrew Metry
Author: Edith Poku
Author: Philip Hykin
Author: Sobha Sivaprasad
Author: A. Toby Prevost
Author: Joana C. Vasconcelos
Author: Caroline Murphy
Author: Joanna Kelly
Author: Yit Yang
Author: Andrew Lotery ORCID iD
Author: Michael Williams
Author: John Brazier

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