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. 2023 Jun 1;141(6):554-561.
doi: 10.1001/jamaophthalmol.2023.1463.

Cost-Utility Comparison of Bevacizumab and Aflibercept in the Treatment of Central or Hemiretinal Vein Occlusion in the SCORE2 Trial

Steven M Kymes  1 , Neal L Oden  2 , Paul C VanVeldhuisen  2 , Ingrid U Scott  3 , Michael S Ip  4 , Barbara A Blodi  5 , Jacquie King  2 ; SCORE2 Investigator Group
Collaborators, Affiliations

Cost-Utility Comparison of Bevacizumab and Aflibercept in the Treatment of Central or Hemiretinal Vein Occlusion in the SCORE2 Trial

Steven M Kymes et al. JAMA Ophthalmol. .

Abstract

Importance: Retinal vein occlusion is the second most common retinal vascular disease. Bevacizumab was demonstrated in the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) to be noninferior to aflibercept with respect to visual acuity in study participants with macular edema due to central retinal vein occlusion (CRVO) or hemiretinal vein occlusion (HRVO) following 6 months of therapy. In this study, the cost-utility of bevacizumab vs aflibercept for treatment of CRVO is evaluated.

Objective: To investigate the relative cost-effectiveness of bevacizumab vs aflibercept for treatment of macular edema associated with CRVO or HRVO.

Design, setting, and participants: This economic evaluation study used a microsimulation cohort of patients with clinical and demographic characteristics similar to those of SCORE2 participants and a Markov process. Parameters were estimated and validated using a split-sample approach of the SCORE2 population. The simulated cohort included 5000 patients who were evaluated 100 times, each with a different set of characteristics randomly selected based on the SCORE2 trial. SCORE2 data were collected from September 2014 October 2019, and data were analyzed from October 2019 to July 2021.

Interventions: Bevacizumab (followed by aflibercept among patients with a protocol-defined poor or marginal response to bevacizumab at month 6) vs aflibercept (followed by a dexamethasone implant among patients with a protocol-defined poor or marginal response to aflibercept at month 6).

Main outcomes and measures: Incremental cost-utility ratio.

Results: The simulation demonstrated that patients treated with aflibercept will have an expected cost $18 127 greater than those treated with bevacizumab in the year following initiation. When coupled with the lack of clinical superiority over bevacizumab (ie, patients treated with bevacizumab had a gain over aflibercept in visual acuity letter score of 4 in the treated eye and 2 in the fellow eye), these results demonstrate that first-line treatment with bevacizumab dominated aflibercept in the simulated cohort of SCORE2 participants. At current price levels, aflibercept would be considered the preferred cost-effective option only if treatment restored the patient to nearly perfect health.

Conclusions and relevance: While there will be some patients with CRVO-associated or HRVO-associated macular edema who will benefit from first-line treatment with aflibercept rather than bevacizumab, given the minimal differences in visual acuity outcomes and large cost differences for bevacizumab vs aflibercept, first-line treatment with bevacizumab is cost-effective for this condition.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr VanVeldhuisen has received grants from the National Eye Institute during the conduct of the study. Dr Scott has received grants from the National Eye Institute during the conduct of the study as well as personal fees from F. Hoffmann-La Roche, Novartis, and Regeneron outside the submitted work. Dr Ip has received personal fees from Novartis, Genentech, Allergan, Boehringer Ingelheim, Astellas, Outlook, Regeneron, RegenexBio, Apellis, Aerie, Alimera, Amgen, Cell Lineage Therapeutics, Clearside, OccuRX, Biogen, and Iveric Bio outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Illustration of Treatment Process Modeled in Economic Evaluation of Treatment of Central Retinal Vein Occlusion (CRVO)
M nodes indicate Markov nodes (ie, the beginning of the Markov cycle). QOL indicates quality of life.
See this image and copyright information in PMC

Comment in

References

    1. Song P, Xu Y, Zha M, Zhang Y, Rudan I. Global epidemiology of retinal vein occlusion: a systematic review and meta-analysis of prevalence, incidence, and risk factors. J Glob Health. 2019;9(1):010427. doi:10.7189/jogh.09.010427 - DOI - PMC - PubMed
    1. Eylea (Aflibercept) injection receives FDA approval for the treatment of macular edema following retinal vein occlusion (RVO). News release. Regeneron. October 6, 2014. Accessed October 13, 2021. https://investor.regeneron.com/news-releases/news-release-details/eylear...
    1. Martin DF, Maguire MG, Ying GS, Grunwald JE, Fine SL, Jaffe GJ; CATT Research Group . Ranibizumab and bevacizumab for neovascular age-related macular degeneration. N Engl J Med. 2011;364(20):1897-1908. doi:10.1056/NEJMoa1102673 - DOI - PMC - PubMed
    1. Wells JA, Glassman AR, Ayala AR, et al. ; Diabetic Retinopathy Clinical Research Network . Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema: two-year results from a comparative effectiveness randomized clinical trial. Ophthalmology. 2016;123(6):1351-1359. doi:10.1016/j.ophtha.2016.02.022 - DOI - PMC - PubMed
    1. Scott IU, VanVeldhuisen PC, Ip MS, et al. ; SCORE2 Investigator Group . Effect of bevacizumab vs aflibercept on visual acuity among patients with macular edema due to central retinal vein occlusion: the SCORE2 randomized clinical trial. JAMA. 2017;317(20):2072-2087. doi:10.1001/jama.2017.4568 - DOI - PMC - PubMed

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