Aflibercept vs. Ranibizumab: cost-effectiveness of treatment for wet age-related macular degeneration in Sweden.

Abstract

Monthly dosing with ranibizumab (RBZ) is needed to achieve maximal visual gains in patients with neovascular ('wet') age-related macular degeneration (wAMD). In Sweden, dosing is performed as needed (RBZ PRN), resulting in suboptimal efficacy. Intravitreal aflibercept (IVT-AFL) every 2months after three initial monthly doses was clinically equivalent to RBZ monthly dosing (RBZ q4) in wAMD clinical trials. We assessed the cost-effectiveness of IVT-AFL versus RBZ q4 and RBZ PRN in Sweden. A Markov model compared IVT-AFL to RBZ q4 or RBZ PRN over 2years. Health states were based on visual acuity in better-seeing eye; a proportion discontinued treatment monthly or upon visual acuity <20/400. Parameters were estimated from trial data, published literature or expert opinion. Analyses were performed from a societal perspective with a lifetime horizon. The model calculated costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs), discounted 3% annually. Deterministic and probabilistic sensitivity analyses were performed. Lifetime cost of IVT-AFL was 578400 SEK, compared with 565700 SEK for RBZ PRN and 686600 SEK for RBZ q4. Compared with RBZ PRN, the ICER of IVT-AFL was 27000 SEK/QALY gained. RBZ q4 cost 20.4 million SEK/QALY gained versus IVT-AFL. Results were sensitive to IVT-AFL efficacy, but IVT-AFL had a 100% probability of being cost-effective versus both RBZ PRN and RBZ q4 at a willingness-to-pay threshold of 500000 SEK. Results suggest, in Sweden, at parity price level, IVT-AFL is less costly than RBZ q4, while demonstrating similar efficacy; IVT-AFL is cost-effective versus RBZ PRN.