Cost-effectiveness of ranibizumab in treatment of diabetic macular oedema (DME) causing visual impairment: evidence from the RESTORE trial.

Abstract

BACKGROUND/AIMS:

To evaluate the cost-effectiveness of ranibizumab as either monotherapy or combined with laser therapy, compared with laser monotherapy, in the treatment of diabetic macular oedema (DME) causing visual impairment from a UK healthcare payer perspective.

METHODS:

A Markov model simulated long-term outcomes and costs of treating DME in one eye (BCVA ≤75 letters) based on data from the RESTORE Phase III trial. Outcomes measured in quality-adjusted life-years (QALYs) were simulated for a 15-year time horizon based on 12-month follow-up from RESTORE and published long-term data. Costs included treatment, disease monitoring, visual impairment and blindness (at 2010 price levels).

RESULTS:

Ranibizumab monotherapy resulted in a 0.17 QALY gain at an incremental cost of £4191 relative to laser monotherapy, yielding an incremental cost-effectiveness ratio (ICER) of £24 028. Probabilistic sensitivity analysis showed a 64% probability of being cost-effective at a threshold of £30 000 per QALY. Combined ranibizumab and laser therapy resulted in a 0.13 QALY gain at an incremental cost of £4695 relative to laser monotherapy (ICER £36 106; 42% probability of ICER <£30 000).

CONCLUSIONS:

Based on RESTORE 1-year follow-up data, ranibizumab monotherapy appears to be cost-effective relative to laser monotherapy, the current standard of care. Cost-effectiveness of combination therapy is less certain. Ongoing studies will further inform on disease progression and the need for additional ranibizumab treatment.

• Authors: Paul Mitchell, Lieven Annemans, Meghan Gallagher, Rafiq Hasan, Simu Thomas, Kerry Gairy, Martin Knudsen, Henrietta Onwordi
• Journal: The British journal of ophthalmology (Br J Ophthalmol) Vol. 96 Issue 5 Pg. 688-93 (May 2012) ISSN: 1468-2079 [Electronic] England
• PMID: 22399690 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Angiogenesis Inhibitors
• Antibodies, Monoclonal, Humanized
• Ranibizumab

Topics

• Angiogenesis Inhibitors (economics)
• Antibodies, Monoclonal, Humanized (economics)
• Combined Modality Therapy
• Cost-Benefit Analysis
• Diabetic Retinopathy (complications, drug therapy, economics)
• Drug Costs
• Humans
• Laser Coagulation
• Macular Edema (complications, drug therapy, economics)
• Markov Chains
• Quality-Adjusted Life Years
• Ranibizumab
• United Kingdom
• Vision Disorders (economics, etiology)
• Visual Acuity