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The Cost-Effectiveness of Ranibizumab Treat and Extend Regimen Versus Aflibercept in the UK



Wet age-related macular degeneration (AMD) is a chronic eye condition that causes severe deterioration of vision and even blindness. Current wet AMD treatment in the UK involves the vascular endothelial growth factor inhibitors ranibizumab and aflibercept. Patients with wet AMD require frequent and long-term monitoring for treatment to be effective, contributing to a substantial resource burden at wet AMD centers. The European license for ranibizumab was recently updated with an individualized ‘treat and extend’ (T&E) regimen, comprising a structured monitoring and treatment protocol. This study evaluated the cost-effectiveness of ranibizumab T&E versus aflibercept within a UK setting.


An individual patient-level simulation model was developed utilizing treatment effects from a network meta-analysis of randomized controlled trials. The model was conducted from a UK National Health Service (NHS) perspective over a lifetime horizon and the base case utilized probabilistic sensitivity analysis to assess uncertainty in the model. Additional scenario analyses were conducted to assess the impact of changes to the model inputs.


Ranibizumab T&E was found to be more effective and less costly than aflibercept, providing, on average, an additional 1.058 quality-adjusted life years (QALYs) and a cost-saving of £19,604 over a lifetime horizon. At list price, ranibizumab T&E was found to be cost-effective versus aflibercept in 100% of simulations at a willingness-to-pay threshold of £20,000 per QALY. The robustness of the results was tested in several scenario analyses; ranibizumab T&E was found to be more effective, and less costly, than aflibercept in the vast majority of cases.


This evaluation suggests that treating patients with ranibizumab according to the T&E regimen could be a better use of NHS resources than aflibercept, and could, therefore, be considered as a first-line regimen for patients with wet AMD in the UK.


Novartis Pharmaceuticals UK Limited.

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All costs associated with the development of this manuscript, and the article processing charges and open access fee for this publication were funded by Novartis Pharmaceuticals UK Limited. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. No further support was provided to the authors with regards to medical writing, editorial or other assistance.


Ruth Pulikottil-Jacob is an employee of Novartis Pharmaceuticals UK Limited. Wrik Ghosh, Rose Wickstead, and Jeanette Kusel are employees of Costello Medical Consulting Ltd., Lindsay Claxton and Matthew Taylor are employees of York Health Economics Consortium, and Kelly Fleetwood is an employee of Quantics, all of whom were contracted by Novartis Pharmaceuticals UK Limited to work on this study.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not involve any new studies of human or animal subjects performed by any of the authors.

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Correspondence to Ruth Pulikottil-Jacob.

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Ghosh, W., Wickstead, R., Claxton, L. et al. The Cost-Effectiveness of Ranibizumab Treat and Extend Regimen Versus Aflibercept in the UK. Adv Ther 33, 1660–1676 (2016).

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  • Age-related macular degeneration
  • Aflibercept
  • Cost-effectiveness
  • Ophthalmology
  • Ranibizumab
  • Treat and extend