Cost-effectiveness of ranibizumab in treatment of diabetic macular oedema (DME) causing visual impairment: evidence from the RESTORE trial. Issue 5 (7th March 2012)

• Record Type: Journal Article
• Authors: Mitchell, Paul; Annemans, Lieven; Gallagher, Meghan; Hasan, Rafiq; Thomas, Simu; Gairy, Kerry; Knudsen, Martin; Onwordi, Henrietta
• Is Part Of: British journal of ophthalmology. Volume 96:Issue 5(2012)
• Page Start: 688
• Page End: 693
• Publication Date: 2012-03-07
• Subjects: Ranibizumab -- diabetic macular oedema -- visual impairment -- cost-effectiveness -- macula -- treatment medical -- clinical trial -- epidemiology -- public health -- vision -- retina; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjophthalmol-2011-300726
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : Background/aims: To evaluate the cost-effectiveness of ranibizumab as either monotherapy or combined with laser therapy, compared with laser monotherapy, in the treatment of diabetic macular oedema (DME) causing visual impairment from a UK healthcare payer perspective. Methods: A Markov model simulated long-term outcomes and costs of treating DME in one eye (BCVA ≤75 letters) based on data from the RESTORE Phase III trial. Outcomes measured in quality-adjusted life-years (QALYs) were simulated for a 15-year time horizon based on 12-month follow-up from RESTORE and published long-term data. Costs included treatment, disease monitoring, visual impairment and blindness (at 2010 price levels). Results: Ranibizumab monotherapy resulted in a 0.17 QALY gain at an incremental cost of £4191 relative to laser monotherapy, yielding an incremental cost-effectiveness ratio (ICER) of £24 028. Probabilistic sensitivity analysis showed a 64% probability of being cost-effective at a threshold of £30 000 per QALY. Combined ranibizumab and laser therapy resulted in a 0.13 QALY gain at an incremental cost of £4695 relative to laser monotherapy (ICER £36 106; 42% probability of ICER <£30 000). Conclusions: Based on RESTORE 1-year follow-up data, ranibizumab monotherapy appears to be cost-effective relative to laser monotherapy, the current standard of care. Cost-effectiveness of combination therapy is less certain. Ongoing studies will further inform on disease progression and the need for additional ranibizumab treatment.