Cost Effectiveness of Ranibizumab vs Aflibercept vs Bevacizumab for the Treatment of Macular Oedema Due to Central Retinal Vein Occlusion: The LEAVO Study.

Abstract

BACKGROUND:

We aimed to assess the cost effectiveness of intravitreal ranibizumab (Lucentis), aflibercept (Eylea) and bevacizumab (Avastin) for the treatment of macular oedema due to central retinal vein occlusion.

METHODS:

We calculated costs and quality-adjusted life-years from the UK National Health Service and Personal Social Services perspective. We performed a within-trial analysis using the efficacy, safety, resource use and health utility data from a randomised controlled trial (LEAVO) over 100 weeks. We built a discrete event simulation to model long-term outcomes. We estimated utilities using the Visual-Functioning Questionnaire-Utility Index, EQ-5D and EQ-5D with an additional vision question. We used standard UK costs sources for 2018/19 and a cost of £28 per bevacizumab injection. We discounted costs and quality-adjusted life-years at 3.5% annually.

RESULTS:

Bevacizumab was the least costly intervention followed by ranibizumab and aflibercept in both the within-trial analysis (bevacizumab: £6292, ranibizumab: £13,014, aflibercept: £14,328) and long-term model (bevacizumab: £18,353, ranibizumab: £30,226, aflibercept: £35,026). Although LEAVO did not demonstrate bevacizumab to be non-inferior for the visual acuity primary outcome, the three interventions generated similar quality-adjusted life-years in both analyses. Bevacizumab was always the most cost-effective intervention at a threshold of £30,000 per quality-adjusted life-year, even using the list price of £243 per injection.

CONCLUSIONS:

Wider adoption of bevacizumab for the treatment of macular oedema due to central retinal vein occlusion could result in substantial savings to healthcare systems and deliver similar health-related quality of life. However, patients, funders and ophthalmologists should be fully aware that LEAVO could not demonstrate that bevacizumab is non-inferior to the licensed agents.

• Authors: Becky Pennington, Abualbishr Alshreef, Laura Flight, Andrew Metry, Edith Poku, Philip Hykin, Sobha Sivaprasad, A Toby Prevost, Joana C Vasconcelos, Caroline Murphy, Joanna Kelly, Yit Yang, Andrew Lotery, Michael Williams, John Brazier
• Journal: PharmacoEconomics (Pharmacoeconomics) Vol. 39 Issue 8 Pg. 913-927 (08 2021) ISSN: 1179-2027 [Electronic] New Zealand
• PMID: 33900585 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2021. The Author(s).

Chemical References

• Angiogenesis Inhibitors
• Recombinant Fusion Proteins
• aflibercept
• Bevacizumab
• Receptors, Vascular Endothelial Growth Factor
• Ranibizumab

Topics

• Angiogenesis Inhibitors (therapeutic use)
• Bevacizumab (therapeutic use)
• Cost-Benefit Analysis
• Humans
• Macular Edema (drug therapy, etiology)
• Quality of Life
• Ranibizumab
• Receptors, Vascular Endothelial Growth Factor (therapeutic use)
• Recombinant Fusion Proteins (therapeutic use)
• Retinal Vein Occlusion (complications, drug therapy)
• State Medicine