Ranibizumab, Verteporfin Photodynamic Therapy or Observation for the Treatment of Myopic Choroidal Neovascularization: Cost Effectiveness in the UK

Abstract

PurposeThe aim of this study was to evaluate the cost effectiveness of ranibizumab compared with verteporfin photodynamic therapy (vPDT) or no treatment (observation) in patients with visual impairment due to myopic choroidal neovascularization (CNV).MethodsA Markov model with health states defined by best-corrected visual acuity and a 3-month cycle length was developed. It had a healthcare provider (UK National Health Service and personal social services) perspective, a lifetime time horizon, and was based on 2011 prices; future costs and health outcomes were discounted at 3.5 % per annum. Baseline characteristics were based on the phase III RADIANCE (Ranibizumab and vPDT Evaluation in Myopic CNV) study, and year 1 health-state transitions were based on this and the VIP (Verteporfin in Photodynamic Therapy) study. Extensive sensitivity analyses tested the robustness of the model.ResultsThe lifetime cost of treating myopic CNV with ranibizumab was £12,866, whereas vPDT and observation were associated with total costs of £14,421 and £8,163, respectively. Ranibizumab treatment produced higher cumulative quality-adjusted life-years (QALYs; 12.99) than vPDT (12.60) or observation (12.45). Ranibizumab treatment was therefore dominant, with greater health gains and lower overall costs than vPDT. Ranibizumab was cost effective compared with observation, with an incremental cost-effectiveness ratio of £8,778/QALY. In the probabilistic sensitivity analysis, ranibizumab had a 100 % and 88 % probability of being cost effective compared with vPDT and observation, respectively, at a willingness-to-pay threshold of £20,000/QALY.ConclusionThis study indicates that ranibizumab therapy is dominant over vPDT for the treatment of visual impairment due to CNV secondary to pathologic myopia in the UK healthcare setting and cost effective compared with observation.Electronic supplementary materialThe online version of this article (doi:10.1007/s40266-014-0216-y) contains supplementary material, which is available to authorized users.

Cost–effectiveness analysis of ocriplasmin versus watchful waiting for treatment of symptomatic vitreomacular adhesion in the US

“…In addition, a change of ten letters or more is considered clinically meaningful [28] and is consistent with the secondary end point in the ocriplasmin clinical trial program [2,3]. Blindness was represented by a letter count of ≤35 letters in the better-seeing eye (BSE; VA7 and VA8, Figure 1), consistent with other economic models in ophthalmology [29] and studies that have estimated costs associated with severe vision loss [30,31]. This state-transition model was structured as a partitioned vision distribution model such that each disease health state was associated with a unique distribution of VA categories 1-8 (Figure 2), represented by a beta distribution with parameters estimated from the OASIS trial BCVA data.…”

Aflibercept as primary treatment for myopic choroidal neovascularisation: a retrospective study

“…Indeed, the 1-year results from the VIEW 1 and VIEW 2 studies showed that in the treatment of CNV due to AMD, aflibercept was non-inferior under similar dosing regimens to ranibizumab. 24 , 25 , 26 , 27 , 28 Here, aflibercept maintained the visual gains obtained in the first year of the study with significantly fewer injections compared with ranibizumab.…”

“…This factor, in conjunction with treatment-related cumulative damage to the photoreceptors and the underlying retinal pigment epithelium, might compromise the long-term results, as underlined by the relatively few aflibercept injections needed in the present study. Several studies 24 , 25 , 26 , 27 and an open-label, non-comparative phase II trial known as REPAIR (Ranibizumab for the trEatmentof CNV secondary to pathological myopia; an Individualised Regimen) 28 , 29 have shown beneficial results of intravitreal ranibizumab for myopic CNV. Twelve-month data from the phase II study indicated that ranibizumab was associated with significant improvements of BCVA score and central macular thickness.…”

Cost of Myopia Correction: A Systematic Review

“…All costs are quoted in US dollars ($). Conversion rate used was Euro to USD = 1:1.12 ( 22 , 27 ) and Pound sterling to USD = 1:1.31 ( 28 ), using average 2019 exchange rates ( 29 ).…”