The cost-effectiveness of initiating ranibizumab therapy in eyes with neovascular AMD with good vision: an economic model using real-world outcomes. Issue 5 (5th May 2015)

• Record Type: Journal Article
• Authors: Butt, Thomas; Lee, Aaron; Lee, Cecilia; Tufail, Adnan
• Other Names: Xing Wen author non-byline.; Johnston Robert L author non-byline.; Egan Catherine author non-byline.; Keane Pearse author non-byline.; Sim Dawn author non-byline.; Akerele Toks author non-byline.; McKibbin Martin author non-byline.; Downey Louise author non-byline.; Natha Salim author non-byline.; Chakravarthy Usha author non-byline.; Bailey Clare author non-byline.; Khan Rehna author non-byline.; Antcliff Richard author non-byline.; Armstrong Stewart author non-byline.; Varma Atul author non-byline.; Kumar Vineeth author non-byline.; Tsaloumas Marie author non-byline.; Mandal Kaveri author non-byline.; Bunc Catey author non-byline.
• Is Part Of: BMJ open. Volume 5:Issue 5(2015)
• Publication Date: 2015-05-05
• Subjects: ranibizumab -- neovascular AMD -- cost-effectiveness -- electronic medical record; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2014-006535
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objectives: To evaluate the cost-effectiveness of immediate treatment with ranibizumab in patients with neovascular age-related macular degeneration (nAMD) with good (better than 6/12) starting visual acuity compared with current UK clinical guidance of waiting until vision falls below 6/12 to begin treatment, using real-world outcomes data. Design: A patient-level health economic state transition model based on levels of visual acuity in the better seeing eye was constructed to simulate the costs and consequences of treating patients with nAMD with ranibizumab. Setting: The model took the perspective of the UK National Health Service (NHS). Participants: The model was populated with real-world outcomes and resource use from a prospective multicentre national nAMD database study containing 92 976 ranibizumab treatment episodes. Interventions: Two treatment approaches were compared: immediate intervention with 0.5 mg ranibizumab pro re nata, PRN (on detection of nAMD) or delayed intervention (waiting until vision fell to 6/12 before beginning treatment). Main outcome measures: Quality-adjusted life years (QALYs) for health states and healthcare costs were accrued for each strategy, and an incremental cost-effectiveness ratio (ICER) was calculated. One-way and probabilistic sensitivity analyses were employed to test the uncertainty of the model. Results: Over a 2-year time horizon, based on 10 000 Monte Carlo simulations, the early treatment arm accumulated 1.59 QALYs and £8469.79 cost. The delayed treatment arm accumulated 1.35 QALYs and £7460.21 cost. The central ICER estimate was £4251.60. Conclusions: A model based on real-world data is likely to be a realistic reflection of the health gains and resource use of ranibizumab for nAMD in the UK NHS. Initiating treatment immediately with ranibizumab PRN regimen is a cost-effective strategy compared with current guidance of initiating treatment at a level of 6/12 or worse vision.