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. 2012 May;96(5):688-93.
doi: 10.1136/bjophthalmol-2011-300726. Epub 2012 Mar 7.

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

Paul Mitchell  1 , Lieven Annemans, Meghan Gallagher, Rafiq Hasan, Simu Thomas, Kerry Gairy, Martin Knudsen, Henrietta Onwordi
Affiliations

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

Paul Mitchell et al. Br J Ophthalmol. 2012 May.

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.

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Conflict of interest statement

Competing interests: PM has received a consultancy fee from Novartis Pharma AG, Pfizer, Solvay and Allergan. He has also been paid lecture fees/honoraria by Novartis Pharma AG, Pfizer, Solvay and Allergan. LA has received unrestricted grants from Novartis Pharma AG. SKT is an employee of Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA. KG is an employee of Novartis Pharmaceuticals, Frimley, UK. RH is an employee of Novartis Pharma AG, Basel, Switzerland and a Novartis shareholder. MK and HO were employed as consultants by Novartis Pharma AG for this study. MG was formerly employed by Novartis Pharma AG, Basel, Switzerland; current affiliation Amgen Inc., Thousand Oaks, CA, USA.

Figures

Figure 1
Figure 1
Markov model structure. Health states are defined by best corrected visual acuity (BCVA) in the treated eye. Patients enter the model at treatment start where they are assumed to have BCVA as in RESTORE (>39 letters and ≤75 letters). BCVA is evaluated at 3-monthly intervals. After each cycle, patients may transition to any other health state including death; the probability of moving from health state A to health state B is based on RESTORE data (baseline to month 12) and literature.
Figure 2
Figure 2
Modelled distribution by health states after (A) 1 and (B) 15 years. BCVA, best corrected visual acuity.
See this image and copyright information in PMC

References

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