Cost-effectiveness of ranibizumab compared with pegaptanib in neovascular age-related macular degeneration
- First Online:
To assess the cost-effectiveness of ranibizumab compared with pegaptanib in the treatment of patients with minimally classic/occult neovascular age-related macular degeneration (AMD), from a societal perspective in Spain.
We constructed a Markov model with five states defined by visual acuity (VA) in the better-seeing eye (Snellen scale): VA >20/40, ≤20/40 to >20/80, ≤20/80 to >20/200, ≤20/200 to >20/400, ≤20/400, and an additional death state. Two cohorts of patients were distributed along the VA states, and treated with either ranibizumab or pegaptanib. Transition probabilities assigned for movement between these states with both drugs were obtained from published randomized clinical trials. Medical costs related to AMD treatment and follow-up, medical costs related to AMD comorbidities, and non-medical-related costs were taken into account. Costs (2008 Euro), health outcomes (Quality-adjusted life years—QALYs), both discounted at a 3.5% annual rate, and incremental cost-effectiveness ratios (ICER: €/QALY), were determined for a lifetime horizon in the base case analysis. Sensitivity analyses were conducted to explore different scenarios and assumptions in the model.
Treating patients with varying degrees of visual impairment with monthly ranibizumab instead of pegaptanib was €71,206 more costly and provided 2.437 additional QALYs (€29,224/QALY). When administered on an as-needed basis, as in the Prospective Optical Coherence Tomography Imaging of Patients with Neovascular AMD Treated with Intraocular Ranibizumab (PrONTO) trial, the cost per QALY gained with ranibizumab was reduced to €4,623.
The cost per QALY gained with monthly ranibizumab compared with pegaptanib in the minimally classic/occult neovascular AMD population is just below the €30,000 threshold below which new drugs are sometimes regarded as cost-effective strategies in Spain. In this model, the key variables with greater impact on the cost-effectiveness results were the selected time horizon and the chosen extrapolation method, the source for data on pegaptanib efficacy and the number of ranibizumab injections. When administered on an as-needed basis, ranibizumab was a cost-effective strategy compared to pegaptanib in this population.
KeywordsAge-related macular degeneration Ranibizumab Pegaptanib Cost-effectiveness Cost-utility
- 5.Chakravarthy U, Adamis AP, Cunningham ET Jr, Goldbaum M, Guyer DR, Katz B, Patel M (2006) Year 2 efficacy results of 2 randomized controlled clinical trials of pegaptanib for neovascular age-related macular degeneration. Ophthalmology 113(1508):e1501–e1525Google Scholar
- 10.Avery RL, Pieramici DJ, Rabena MD, Castellarin AA, Nasir MA, Giust MJ (2006) Intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration. Ophthalmology 113(363–372):e365Google Scholar
- 14.Comparison of AMD Treatments Trials (CATT): Lucentis - Avastin Trial. National Eye Institute. Available at: http://www.nei.nih.gov/CATT. Accesed: 23rd of June, 2009
- 20.Tablas de supervivencia de la población española. Instituto Nacional de Estadística [National Statistics Institute]. Available at: http://www.ine.es/jaxi/tabla.do?path=/t20/p319a/1992-2005/l0/&file=01001.px&type=pcaxis. Accesed: 4th of June 2009
- 21.Drummond M, Sculpher M, Torrance G, O’Brien B, Stoddart G (2005) Economic evaluation using decision analytic modelling. In: Methods for the economic evaluation of health care programmes, 3rd ed. Oxford University Press, Oxford, pp 277–314Google Scholar
- 23.Pesos españoles y coste SNS. Año 2005. Ministerio de Sanidad y Consumo. [Health Ministry]. Available at: http://www.msc.es. Accesed: 26th december 2008
- 24.Indice de precios de consumo. Instituto Nacional de Estadística [National Statistics Institute]. Available at: http://www.ine.es/daco/ipc.htm. Accesed: 4th june 2009
- 25.Drummond M, Sculpher M, Torrance G, O’Brien B, Stoddart G (2005) Basic types of economic evaluation. In: Methods for the economic evaluation of health care programmes, 3rd ed. Oxford University Press, Oxford, pp 7–26Google Scholar
- 27.NICE. Guide to the methods of technology appraisal, june 2008. Available at: http://www.nice.org.uk. Accesed: 26th december 2008
- 30.Fung AE, Lalwani GA, Rosenfeld PJ, Dubovy SR, Michels S, Feuer WJ, Puliafito CA, Davis JL, Flynn HW Jr, Esquiabro M (2007) An optical coherence tomography-guided, variable dosing regimen with intravitreal ranibizumab (Lucentis) for neovascular age-related macular degeneration. Am J Ophthalmol 143:566–583CrossRefPubMedGoogle Scholar
- 31.Rosenfeld PJ (2007) Ranibizumab: The Pronto study. American Academy of Ophthalmology. New Orleans, 10–13th November 2007Google Scholar