A Value-Based Medicine Analysis of Ranibizumab for the Treatment of Subfoveal Neovascular Macular Degeneration
Received 22 January 2007; received in revised form 20 August 2007; accepted 20 August 2007. published online 01 November 2007.
Objective
To assess the conferred value and average cost-utility (cost-effectiveness) for intravitreal ranibizumab used to treat occult/minimally classic subfoveal choroidal neovascularization associated with age-related macular degeneration (AMD).
Design
Value-based medicine cost-utility analysis.
Participants
MARINA (Minimally Classic/Occult Trial of the Anti–Vascular Endothelial Growth Factor Antibody Ranibizumab in the Treatment of Neovascular AMD) Study patients utilizing published primary data.
Methods
Reference case, third-party insurer perspective, cost-utility analysis using 2006 United States dollars.
Main Outcome Measures
Conferred value in the forms of (1) quality-adjusted life-years (QALYs) and (2) percent improvement in health-related quality of life. Cost-utility is expressed in terms of dollars expended per QALY gained. All outcomes are discounted at a 3% annual rate, as recommended by the Panel on Cost-effectiveness in Health and Medicine. Data are presented for the second-eye model, first-eye model, and combined model.
Results
Twenty-two intravitreal injections of 0.5 mg of ranibizumab administered over a 2-year period confer 1.039 QALYs, or a 15.8% improvement in quality of life for the 12-year period of the second-eye model reference case of occult/minimally classic age-related subfoveal choroidal neovascularization. The reference case treatment cost is $52652, and the cost-utility for the second-eye model is $50691/QALY. The quality-of-life gain from the first-eye model is 6.4% and the cost-utility is $123887, whereas the most clinically simulating combined model yields a quality-of-life gain of 10.4% and cost-utility of $74169.
Conclusions
By conventional standards and the most commonly used second-eye and combined models, intravitreal ranibizumab administered for occult/minimally classic subfoveal choroidal neovascularization is a cost-effective therapy. Ranibizumab treatment confers considerably greater value than other neovascular macular degeneration pharmaceutical therapies that have been studied in randomized clinical trials.
Available online: November 5, 2007.
1Center for Value-Based Medicine, Flourtown, Pennsylvania.
2Department of Ophthalmology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
3Eye Research Institute, Philadelphia, Pennsylvania.
4Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
5Retina Service, Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania.
Correspondence to Melissa M. Brown, MD, MBA, Center for Value-Based Medicine, Box 335, Flourtown, PA 19031.
Manuscript no. 2007-93.
Supported in part by a grant from Genentech, Inc., South San Francisco, California. The sponsor played no part in suggesting or requiring direction of the study.
ABSTRACT