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Ophthalmology: Original article

A United Kingdom-based economic evaluation of ranibizumab for patients with retinal vein occlusion (RVO)

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Pages 423-434 | Accepted 25 Mar 2014, Published online: 22 Apr 2014
 

Abstract

Objective:

This study compares the cost-effectiveness of intravitreal ranibizumab vs observation and/or laser photocoagulation for treatment of macular edema secondary to retinal vein occlusion in a UK-based model.

Methods:

A Markov model was constructed using transition probabilities and frequency of adverse events derived using data from the BRAVO, CRUISE, and HORIZON trials. Outcomes associated with treatments and health states were combined to predict overall health costs and outcomes for cohorts treated with each option.

Results:

In branch retinal vein occlusion, ranibizumab produced a gain of 0.518 quality-adjusted life years at an incremental cost of £8141, compared with laser photocoagulation. The incremental cost-effectiveness ratio was £15,710 per quality-adjusted life year, and the incremental cost per month free from blindness was £658. In central retinal vein occlusion, ranibizumab produced a gain of 0.539 quality-adjusted life years at an incremental cost of £9216, compared with observation only. The incremental cost-effectiveness ratio was £17,103, and the incremental cost per month free from blindness was £423.

Conclusions:

These incremental cost-effectiveness ratios are below the £20,000–30,000 range typically accepted as a threshold for cost-effectiveness. This suggests that ranibizumab may be regarded as a cost-effective therapy for patients with macular edema secondary to retinal vein occlusion, relative to grid laser photocoagulation (for BRVO) and observation (for CRVO). Limitations include sparse data for utilities associated with the severity of visual impairment in the WSE in patients with RVO. A lack of direct comparative evidence between ranibizumab and the dexamethasone intravitreal implant for the treatment of BRVO and CRVO and the infeasibility of an indirect comparison due to significant heterogeneity in trial designs prevented the inclusion of this treatment as a comparator in the Markov model.

Transparency

Declaration of funding

This study was funded by Novartis Pharma AG.

Declaration of financial/other relationships

Matthew Taylor, Elçin Serbetci, and Lily Lewis are employees of York Health Economics Consortium Ltd. Alberto Ferreira is an employee of Novartis and owns shares in the company. Kerry Gairy was an employee of Novartis Pharmaceuticals UK Limited, Surrey, UK at the time the study was conducted. Julie Blouin was an employee of Novartis Pharmaceuticals Canada Inc. Dorval, Quebec, Canada at the time the study was conducted. Paul Mitchell is an academic and has received honoraria and travel support from Novartis and Bayer as a consultant. JME Peer Reviewers on this manuscript have no relevant financial relationships to disclose.

Acknowledgments

This manuscript has been prepared with editorial assistance from Dr Martin Bell of Oxford PharmaGenesis™ Ltd, Oxford, UK, funded by Novartis.

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