Bevacizumab Beats Ranibizumab in Cost-Effectiveness Study for Macular Degeneration

By Will Boggs MD

February 14, 2014

NEW YORK (Reuters Health) - Bevacizumab is more cost-effective than ranibizumab for the treatment of newly diagnosed neovascular macular degeneration, according to a mathematical model.

"The results of the models were not overly surprising since it is well known that there is such a large cost differential between ranibizumab and bevacizumab coupled with the fact that the CATT trial did not seem to demonstrate much of a difference in efficacy or safety between the two products," Dr. Joshua D. Stein from University of Michigan in Ann Arbor told Reuters Health by email.

At an annual cost of $1.6 billion for retinal diseases, ranibizumab represents the single largest expenditure for Medicare, accounting for almost 10% of the entire drug budget.

Dr. Stein and colleagues used a Markov model to determine the most cost-effective treatment for patients with newly diagnosed neovascular macular degeneration. They compared monthly or as-needed bevacizumab injections with monthly or as-needed ranibizumab injections in a hypothetical cohort of 80-year-old patients.

In the base model, as-needed bevacizumab proved most cost-effective. In comparison, the incremental cost-effectiveness ratios (ICER) were $242,357 per quality-adjusted life-year (QALY) for monthly bevacizumab and more than $10 million per QALY for monthly ranibizumab.

Monthly bevacizumab had both lower costs and higher QALYs than as-needed ranibizumab, according to the January 8 Ophthalmology online report.

When the model was rerun after excluding visit and OCT costs after the initial visit for monthly treatment recipients, monthly bevacizumab proved less expensive than as-needed bevacizumab unless monthly bevacizumab required five or more visits and OCTs annually.

Monthly ranibizumab was still more than $10 million per QALY more costly than monthly bevacizumab.

As-needed ranibizumab would be the most cost-effective treatment only if the cost of each ranibizumab injection was reduced from $2389 to $750 and the cost of each bevacizumab injection was increased from $356 to $800, the researchers note.

"When each parameter was simultaneously varied in a probabilistic sensitivity analysis, as-needed bevacizumab was preferred in nearly two-thirds of the simulations by using a willingness to pay of $100,000 per QALY," the authors say. "Monthly bevacizumab was preferred in another 18% to 20% of simulations."

"A finding that I thought was surprising from our analyses was the fact that the rate of serious systemic adverse events would need to be 2.5 times higher with bevacizumab for it to become the less cost-effective treatment option," Dr. Stein said. "One would think that if indeed users of bevacizumab had a 2.5 times higher rate of serious systemic side effects compared to others taking ranibizumab, that such a difference in safety profile would have been recognized in a large trial like CATT and by clinicians who routinely administer these medications in clinical practice."

"The main message of our study is to highlight for clinicians and policy makers that bevacizumab is a considerably more cost effective treatment option than ranibizumab for treatment of neovascular AMD and that incentivizing providers to treat their patients with bevacizumab may lead to considerable cost savings with minimal impact on patient outcomes," Dr. Stein concluded.

"There is a role for ranibizumab for neovascular AMD in settings where there is no or limited access to bevacizumab," Dr. Stein added.

There was no pharmaceutical industry involvement in this study.

SOURCE: http://bit.ly/1g27nNA

Ophthalmology 2014.

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