Cost-Effectiveness Analysis of Ranibizumab versus Verteporfin Photodynamic Therapy, Pegaptanib Sodium, and Best Supportive Care for the Treatment of Age-Related Macular Degeneration in Greece

Abstract

BackgroundAge-related macular degeneration (AMD) is a progressive disease that results in loss of central vision, significant functional impairment, and a subsequent heavy socioeconomic burden. AMD treatments delay disease progression, improve patient outcomes, and reduce resource use associated with visual impairment, however, in a varying way concerning costs and effects. ObjectiveThe purpose of this study was to investigate the cost effectiveness of ranibizumab compared with verteporfin photodynamic therapy, pegaptanib sodium, and best supportive care for the treatment of AMD in Greece. MethodsA 6-state Markov model was constructed according to patient visual acuity in the better-seeing eye. Data on effectiveness were derived from randomized controlled trials evaluating the outcomes of ranibizumab versus alternative AMD treatments. Resource utilization reflected the Greek health care setting and was defined by a panel of experts. All treatments were administered for a 2-year period and evaluated during a 10-year time frame from a third-party payer perspective and discounted at 3.5% per annum. ResultsEstimated mean 10-year direct costs of treatment in the ranibizumab arm ranged from €23,733 to €31,795 (2011 Euros), with a projected gain of 4.50 to 4.74 quality-adjusted life years (QALYs) or 2.97 to 4.47 vision years, depending on type of lesion. For predominantly classic lesions, the cost per QALY gained with ranibizumab was estimated at €6444/QALY (95% uncertainty interval [UI], €−30,403/QALY to €44,524/QALY), €15,344 (95% UI, €−11,433 to €53,554) and dominant relative to photodynamic therapy, best supportive care, and pegaptanib, respectively. Corresponding ratios for patients with minimally classic lesions were €24,580/QALY (95% UI, €−5580/QALY to €76,229/QALY) and €13,112/QALY (95% UI, €−3839/QALY to €37,527/QALY) for ranibizumab relative to best supportive care and pegaptanib, and for patients with occult lesions were estimated at €19,407/QALY (95% UI, €−1486 to €46,434) and €28,561/QALY (95% UI, €6143 to 73,431), respectively. Sensitivity analysis provided robust results in all cases. ConclusionRanibizumab can be a cost-effective option for the treatment of AMD compared with selected alternatives in the Greek health care setting.