Not cost-effective for diabetic macular edema unless prices decrease considerably
FRIDAY, June 10, 2016 (HealthDay News) — Compared with bevacizumab, aflibercept and ranibizumab are not cost-effective for diabetic macular edema (DME), according to research published online June 9 in JAMA Ophthalmology.
Eric L. Ross, from the University of Michigan Medical School in Ann Arbor, and colleagues conducted a post-hoc analysis of efficacy, safety, and resource utilization data at one-year follow-up from the Diabetic Retinopathy Clinical Research Network Comparative Effectiveness Trial to examine the incremental cost-effectiveness ratios (ICERs) of aflibercept, bevacizumab, and ranibizumab. Data were included for 624 participants with DME (209, 207, and 208 treated with aflibercept, bevacizumab, and ranibizumab, respectively).
The researchers found that during one year, the ICERs of aflibercept and ranibizumab versus bevacizumab were $1,110,000 and $1,730,000 per quality-adjusted life-year (QALY), respectively. During 10 years, the ICERs were $349,000 and $603,000 per QALY, respectively. The ICER for aflibercept compared with ranibizumab was $648,000 and $203,000 per QALY at one and 10 years, respectively. To reach a cost-effectiveness threshold of $100,000 per QALY compared with bevacizumab during a 10-year horizon, treatment costs of aflibercept and ranibizumab would need to decrease by 69 and 80 percent, respectively, in eyes with decreased vision from DME. The costs would need to decrease by 62 and 84 percent, respectively, for the subgroup with worse baseline vision.
“These results highlight the challenges that physicians, patients, and policymakers face when safety and efficacy results are at odds with cost-effectiveness results,” the authors write.
Several authors disclosed financial ties to pharmaceutical companies, including Genentech (manufacturer of bevacizumab and ranibizumab) and Regeneron (manufacturer of aflibercept).
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