Economic evaluation of ranibizumab in the treatment of exudative age-related macular degeneration (AMD)

Abstract

Objective: To assess the cost-effectiveness of ranibizumab (LUC) versus best supportive care (BSC), verteporfin photodynamic therapy (PDT), and pegaptanib (MAC) in wet age-related macular degeneration (AMD), from a public payer perspective in Brazil (SUS). Methods: The adopted outcome for the cost- -effectiveness evaluation was ‘vision years gained’ (VYG), defined as years spent with a visual acuity (VA) >20/200. A Markov state transition model was designed to simulate the evolution of VA over 10-years time horizon. Efficacy data were obtained from the MARINA, ANCHOR, PIER, TAP, EXCITE, SUSTAIN and MONTBLANC clinical trials. Based on a panel of clinical experts, direct AMD related medical resource utilization patterns were assessed and unit costs were obtained from Brazilian official lists. Only AMD-related direct costs were included. Both deterministic and probabilistic sensitivity analyses were performed. Annual discount rate of 5% was applied both to costs and outcomes. Results: Base case analysis estimated incremental VYG for LUC of 0.06 versus MAC, 0.98 versus BSC, and 1.16 versus PDT. Total AMD treatment costs were 25,995BRL, 1,113BRL, 24,923BRL, and 36,419BRL for LUC, BSC, PDT and MAC, respectively. LUC was cost-saving as compared to MAC (incremental cost of -10,424BRL) and the projected ICER was 927BRL per VYG versus PDT and 25,439BRL versus BSC. Probabilistic sensitivity analysis showed LUC as dominant in 70% of iterations versus MAC and in 50% of iterations versus PDT. When a hypothetical acceptability threshold of 30,000BRL was set, LUC was cost-effective in 73%, 99% and 86% of all scenarios versus BSC, PDT and MAC, respectively. Conclusion: LUC exhibited incremental clinical effectiveness across all comparisons and an acceptable cost-effectiveness profile as compared to active competing alternatives.