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Author Notes:

Gary C. Brown, Phone: 215-353-6248, Email: gbrown@valuebasedmedicine.com

Acquisition, analysis and interpretation of data: GCB, MMB, HBL.

Drafting of manuscript and revising intellectual content: GCB, MMB, HBL, AT, YR.

Final approval of manuscript: GCB, MMB, HBL, AT, YR.

Accountable for manuscript accuracy and integrity: GCB, MMB.

All authors read and approved the final manuscript.

Competing Interests: Drs. G. Brown and M. Brown are stockholders in the Center for Value-Based Medicine®. Drs. A. Turpcu and Y. Rajput are employees of Genentech, Inc.

Subjects:

Keywords:

  • Ranibizumab
  • Cost-utility analysis
  • Age-related macular degeneration
  • Clinical cost-utility model

The comparative effectiveness and cost-effectiveness of ranibizumab for neovascular macular degeneration revisited

Tools:

Journal Title:

International Journal of Retina and Vitreous

Volume:

Volume 3, Number 1

Publisher:

, Pages 5-5

Type of Work:

Article | Final Publisher PDF

Abstract:

Background To compare a near decade of follow-up, newer control cohort data, use of both the societal and third party insurer cost perspectives, and integration of unilateral/bilateral therapy on the comparative effectiveness and cost-effectiveness of intravitreal ranibizumab therapy for neovascular, age-related macular degeneration (AMD). Methods Value-Based Medicine®, 12-year, combined-eye model, cost-utility analysis employing MARINA and HORIZON clinical trial data. Preference-based comparative effectiveness outcomes were quantified in (1) QALY (quality-adjusted life-year) gain, and (2) percent improvement in quality-of-life, while cost-effectiveness outcomes were quantified in (3) the cost-utility ratio (CUR) and financial return-on-investment (ROI) to society. Results Using MARINA and HORIZON trial data and a meta-analysis control cohort after 24 months, ranibizumab therapy conferred a combined-eye patient value (quality-of-life) gain of 16.3%, versus 10.4% found in 2006. The two-year direct ophthalmic medical cost for ranibizumab therapy was $46,450, a 33.8% real dollar decrease from 2006. The societal cost perspective CUR was −$242,920/QALY, indicating a $282,517 financial return-on-investment (ROI), or 12.3%/year to society for direct ophthalmic medical costs expended. The 3rd party insurer CUR ranged from $21,199/QALY utilizing all direct, medical costs, to $69,591/QALY using direct ophthalmic medical costs. Conclusions Ranibizumab therapy for neovascular AMD in 2015, considering treatment of both eyes, conferred greater patient value gain (comparative effectiveness) and improved cost-effectiveness than in 2006, as well as a large monetary return-on-investment to the Gross Domestic Product and nation’s wealth. The model herein integrates important novel features for neovascular age-related macular degeneration, vitreoretinal cost effectiveness analyses, including: (1) treatment of both eyes, (2) a long-term, untreated control cohort, and (3) the use of societal costs.

Copyright information:

© The Author(s) 2017

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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