Diabetic macular edema: cost-efficacy of ranibizumab vs aflibercept

  • Holekamp N & al.
  • J Med Econ
  • 10/09/2019

  • Craig Hicks
  • Clinical Essentials
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Takeaway

  • Ranibizumab (Lucentis) 0.3 mg is more cost-effective than aflibercept (Eylea) 2.0 mg for treating diabetic macular edema (DME), an advanced, vision-threatening complication of diabetic retinopathy.

Why this matters

  • Treatment cost-effectiveness and effect on health-related QoL are important considerations when choosing an appropriate treatment for DME.

Study design

  • Researchers modeled medication costs, visual acuity (VA)-related medical costs, and quality-adjusted life-years (QALYs) based on Medicare reimbursement rates in 2016 U.S. dollars and published literature.
  • They stratified patients by baseline VA≥20/40 and ≤VA 20/50.
  • Funding: Genentech.

Key results

  • Total 2-year costs were higher with similar quality-adjusted life-years (QALYs) for aflibercept vs ranibizumab in all groups:
    • All patients: $44,423 vs $34,529; 1.476 vs 1.466.
    • VA ≥ 20/40: $40,854 vs $31,897; 1.517 vs 1.519.
    • VA ≤ 20/50: $48,214 vs $37,246; 1.433 vs 1.412.
  • Incremental cost-effectiveness ratios were also higher for aflibercept in the full cohort ($986,159/QALY) and VA ≤20/50 ($523,377/QALY).
  • These ratios decreased to $711,301/QALY and $246,978/QALY, respectively, when researchers projected analyses to 10 years.

Limitations

  • VA was the only QALY parameter researchers analyzed.
  • Analyses specifically excluded bevacizumab (Avastin), which is commonly used off-label to treat DME.