Research
Cost-effectiveness of ranibizumab for neovascular age-related macular degeneration
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* Corresponding author: Susan F Hurley susanhurley@bainbridgeconsultants.com
1 Bainbridge Consultants, 222/299 Queen St, Melbourne, VIC 3000, Australia
2 School of Medicine, Griffith University, Australia
3 School of Population Health, The University of Melbourne, Australia
4 Macular Research Unit, Department of Ophthalmology, Centre for Eye Research Australia, The University of Melbourne, Australia
Cost Effectiveness and Resource Allocation 2008, 6:12 doi:10.1186/1478-7547-6-12
Published: 24 June 2008Abstract
Background
Intravitreal ranibizumab prevents vision loss and improves visual acuity in patients with neovascular age-related macular degeneration, but it is expensive, and efficacy beyond 2 years is uncertain.
Methods
We assessed the cost-effectiveness of ranibizumab compared with no ranibizumab over 10 years, using randomized trial efficacy data for the first 2 years, post-trial efficacy assumptions, and ranibizumab acquisition costs ranging from the wholesale price ($1,950 per dose) to the price of bevazicumab ($50), a similar molecule which may be equally efficacious. We used a computer simulation model to estimate the probability of blindness, the number of quality-adjusted life-years (QALYs), direct costs (in 2004 U.S. dollars), and cost-effectiveness ratios for a 67-year old woman. Costs and QALYs were discounted at 3% per year.
Results
The probability of blindness over 10 years was reduced from 56% to 34% if ranibizumab was efficacious for only 2 years, 27% if efficacy was maintained for a further 2 years only (base-case scenario), and 17% if visual acuity at 4 years was then sustained. It was cost-saving under all price assumptions, when caregiver costs were included. When caregiver costs were excluded, the cost per QALY for the base-case ranged from $5,600, assuming the bevazicumab price, to $91,900 assuming the wholesale ranibizumab price. The cost per QALY was < $50,000 when the cost of ranibizumab was less than $1000.
Conclusion
From a societal perspective, ranibizumab was cost-saving. From a health care funder's perspective, ranibizumab was an efficient treatment when it cost less than $1000 per dose.