Abstract
Purpose. To assess the cost-effectiveness of bevacizumab compared to ranibizumab, verteporfin photodynamic therapy (PDT), and usual care for the treatment of age-related macular degeneration (AMD) in China. Methods. A Markov model was developed according to patient visual acuity (VA) in the better-seeing eye (Snellen scale). Four cohorts of patients were treated with one of the following therapies: bevacizumab, ranibizumab, PDT, or usual care. Clinical data related to treatments were obtained from published randomized clinical trials. Direct medical costs and resource utilization in the Chinese health care setting were taken into account. Health and economic outcomes were evaluated over a lifetime horizon. Sensitivity analyses were performed. Results. Treatment with ranibizumab provided the greatest gains in quality-adjusted life-years (QALYs). The cost per marginal QALY gained with bevacizumab over usual care was $1,258, $3,803, and $2,066 for the predominantly classic, minimally classic, and occult lesions, respectively. One-way sensitivity analysis showed considerably influential factors, such as utility values and effectiveness data. Probabilistic sensitivity analysis indicated that, compared to usual care, PDT and ranibizumab most cases would be cost-effective in the bevacizumab arm at a threshold of $7,480/QALY. Conclusion. Bevacizumab can be a cost-effective option for the treatment of AMD in the Chinese setting.
Highlights
Age-related macular degeneration (AMD) is a progressive chronic macular disease of the central retina that leads to vision loss and significant functional impairment worldwide [1]
In patients with predominantly classical, minimally classical, and occult types of lesions, the estimated lifetime costs for the ranibizumab arm were notably 240% higher than usual care, 61% higher than photodynamic therapy (PDT), and 219% higher than bevacizumab; the respective projected marginal gains in quality-adjusted life-years (QALYs) for patients with predominantly classical, minimally classical, and occult types of lesions were 15%, 5%, and 9% for usual care; 9%, 3%, and 6% for PDT; and 2%, 1%, and 1% for bevacizumab
The incremental cost-effectiveness ratio (ICER) of bevacizumab over usual care ranged from $1,258 for predominantly classical to $3,803 for minimally classical, which were lower than the two other active treatment alternatives
Summary
Age-related macular degeneration (AMD) is a progressive chronic macular disease of the central retina that leads to vision loss and significant functional impairment worldwide [1]. In the white population aged 40 years and older, the prevalence of early and late AMD is nearly 6.8% and 1.5%, respectively [2]. The age-specific prevalence of late AMD in Asians was largely similar to that in white people [3]. In China, the prevalence of AMD in the early 1990s was nearly 5%, and over the last decade, the prevalence has increased nearly twofold in the aging population. Blindness caused by AMD has become one of the most important health challenges in China [5]
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