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

https://arctichealth.org/en/permalink/ahliterature279115
Source
Acta Ophthalmol. 2016 Aug;94(5):441-8
Publication Type
Article
Date
Aug-2016
Author
Hemangi R Panchmatia
Karen M Clements
Erin Hulbert
Marianne Eriksson
Kim Wittrup-Jensen
Jonas Nilsson
Milton C Weinstein
Source
Acta Ophthalmol. 2016 Aug;94(5):441-8
Date
Aug-2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Angiogenesis Inhibitors - administration & dosage - economics
Cost-Benefit Analysis
Female
Health Care Costs
Humans
Intravitreal Injections
Male
Markov Chains
Middle Aged
Models, Statistical
Quality-Adjusted Life Years
Randomized Controlled Trials as Topic
Ranibizumab - administration & dosage - economics
Receptors, Vascular Endothelial Growth Factor - administration & dosage
Recombinant Fusion Proteins - administration & dosage - economics
Sweden
Vascular Endothelial Growth Factor A - antagonists & inhibitors
Visual Acuity - drug effects
Wet Macular Degeneration - drug therapy - economics
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 2 months 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 2 years. Health states were based on visual acuity in better-seeing eye; a proportion discontinued treatment monthly or upon visual acuity
PubMed ID
27061020 View in PubMed
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Cost-effectiveness of treating wet age-related macular degeneration at the Kuopio University Hospital in Finland based on a two-eye Markov transition model.

https://arctichealth.org/en/permalink/ahliterature279315
Source
Acta Ophthalmol. 2016 Nov;94(7):652-656
Publication Type
Article
Date
Nov-2016
Author
Pasi Vottonen
Eila Kankaanpää
Source
Acta Ophthalmol. 2016 Nov;94(7):652-656
Date
Nov-2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Angiogenesis Inhibitors - administration & dosage - economics
Bevacizumab - administration & dosage - economics
Cost-Benefit Analysis
Drug Administration Schedule
Female
Finland
Health Expenditures
Hospitals, University
Humans
Intravitreal Injections
Male
Markov Chains
Quality-Adjusted Life Years
Ranibizumab - administration & dosage - economics
Receptors, Vascular Endothelial Growth Factor - administration & dosage
Recombinant Fusion Proteins - administration & dosage - economics
Vascular Endothelial Growth Factor A - antagonists & inhibitors
Wet Macular Degeneration - drug therapy - economics
Abstract
Wet age-related macular degeneration (AMD) is the leading cause of blindness worldwide, which can be treated with regular intraocular anti-vascular endothelial growth factor (VEGF) injections. In this study, we wanted to evaluate whether less frequent injections of aflibercept would make it more cost-effective when compared with ranibizumab and low priced bevacizumab.
We used a two-eye model to simulate the progression and the treatment of the disease. We selected an 8-year period, 3-month cycles and five health states based on the visual acuity of the better-seeing eye. The transition probabilities and utilities attached to the health states were gathered from previous studies. We conducted the analysis from the hospital perspective and we used the health care costs obtained from Kuopio University Hospital. The costs of intraocular adverse events were taken into account.
The incremental cost-effectiveness ratio (ICER) with 3% discount rate (€/QALY) for aflibercept compared with monthly bevacizumab was 1 801 228 and when compared with ranibizumab given as needed, the ICER was minus 3 716 943. The sensitivity analysis showed that a change of 20% of the estimated model parameters or a longer follow-up period did not influence these conclusions.
A two-eye Markov transition model was developed to analyse the cost-effectiveness of wet AMD treatment, as quality of life years (QALYs) are largely based on the visual acuity of the better-seeing eye. Monthly injected bevacizumab was the most cost-effective treatment and monthly ranibizumab the least effective.
PubMed ID
27481048 View in PubMed
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Pharmacologic management of neovascular age-related macular degeneration: systematic review of economic evidence and primary economic evaluation.

https://arctichealth.org/en/permalink/ahliterature142190
Source
Can J Ophthalmol. 2010 Jun;45(3):223-30
Publication Type
Article
Date
Jun-2010
Author
William Hodge
Allan Brown
Steve Kymes
Alan Cruess
Gord Blackhouse
Robert Hopkins
Lynda McGahan
Sanjay Sharma
Irene Pan
Jason Blair
David Vollman
Andra Morrison
Author Affiliation
Department of Ophthalmology, University of Western Ontario, London, Ont. William.Hodge@sjhc.london.on.ca
Source
Can J Ophthalmol. 2010 Jun;45(3):223-30
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Antibodies, Monoclonal - administration & dosage - economics
Antibodies, Monoclonal, Humanized
Canada
Choroidal Neovascularization - drug therapy - economics
Cost-Benefit Analysis
Health Care Costs
Humans
Markov Chains
National Health Programs
Quality-Adjusted Life Years
Wet Macular Degeneration - drug therapy - economics
Abstract
To examine the economic implications for the Canadian health system of pharmacologic treatment of neovascular age-related macular degeneration (AMD).
Systematic review of economic literature and a primary economic evaluation.
Economic literature search identified 392 potentially relevant articles, 12 of which were included for final review.
Studies were included if they met the following criteria: (i) provision of a summary measure of the trade-off between costs and consequences; (ii) participants of 40 years and older with neovascular AMD; (iii) interventions and comparators: comparison of photodynamic therapy using verteporfin (V-PDT), pegaptanib, bevacizumab, ranibizumab, anecortave acetate, intravitreal triamcinolone, placebo, or clinically relevant combinations; and (iv) outcome reported as an incremental measure of the implication of moving from the comparator to the intervention. The following databases were searched through the OVID interface: MEDLINE, EMBASE, BIOSIS Previews, CINAHL, PubMed, Health Economic Evaluations Database (HEED), and the Cochrane Library. For the economic evaluation, we took a decision analytic approach and modeled a cost-utility analysis, conducting it as a microsimulation of a Markov model.
In general, V-PDT is more cost effective than conventional macular laser, and pegaptanib is likely more cost effective than V-PDT. The primary economic analysis revealed ranibizumab to be effective but at an unacceptably high cost per quality-adjusted life year (QALY)(>$50,000 per QALY).
Although ranibizumab is effective for wet AMD, its cost is unacceptably high based on cost-utility theory.
Notes
Comment In: Can J Ophthalmol. 2010 Jun;45(3):211-420628418
PubMed ID
20628420 View in PubMed
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