Cost effectiveness of ranibizumab vs aflibercept vs bevacizumab for the treatment of macular oedema due to central retinal vein occlusion: the LEAVO study.
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Authors
Yang, Yit
Issue Date
2021-04-26
Journal
Type
Article
Peer-Reviewed Publication
Peer-Reviewed Publication
Keywords
Aflibercept
Angiogenesis inhibitors
Avastin
Bevacizumab
Central retinal vein occlusion (CRVO)
Cost-benefit analysis
Cost-effectiveness
Eylea
LEAVO study
Lucentis
Macular oedema
Quality of life
Patient outcomes
Peer-reviewed article
Ranibizumab
Randomised controlled trial
Recombinant fusion proteins
Retina
Retinal vein occlusion
Vascular endothelial growth factor receptors
Angiogenesis inhibitors
Avastin
Bevacizumab
Central retinal vein occlusion (CRVO)
Cost-benefit analysis
Cost-effectiveness
Eylea
LEAVO study
Lucentis
Macular oedema
Quality of life
Patient outcomes
Peer-reviewed article
Ranibizumab
Randomised controlled trial
Recombinant fusion proteins
Retina
Retinal vein occlusion
Vascular endothelial growth factor receptors
Journal Title
PharmacoEconomics
Volume
39
Issue
Begin page
913
End page
927
Abstract
Background: We aimed to assess the cost effectiveness of intravitreal ranibizumab (Lucentis), aflibercept (Eylea) and bevacizumab (Avastin) for the treatment of macular oedema due to central retinal vein occlusion.
Methods: We calculated costs and quality-adjusted life-years from the UK National Health Service and Personal Social Services perspective. We performed a within-trial analysis using the efficacy, safety, resource use and health utility data from a randomised controlled trial (LEAVO) over 100 weeks. We built a discrete event simulation to model long-term outcomes. We estimated utilities using the Visual-Functioning Questionnaire-Utility Index, EQ-5D and EQ-5D with an additional vision question. We used standard UK costs sources for 2018/19 and a cost of £28 per bevacizumab injection. We discounted costs and quality-adjusted life-years at 3.5% annually.
Results: Bevacizumab was the least costly intervention followed by ranibizumab and aflibercept in both the within-trial analysis (bevacizumab: £6292, ranibizumab: £13,014, aflibercept: £14,328) and long-term model (bevacizumab: £18,353, ranibizumab: £30,226, aflibercept: £35,026). Although LEAVO did not demonstrate bevacizumab to be non-inferior for the visual acuity primary outcome, the three interventions generated similar quality-adjusted life-years in both analyses. Bevacizumab was always the most cost-effective intervention at a threshold of £30,000 per quality-adjusted life-year, even using the list price of £243 per injection.
Conclusions: Wider adoption of bevacizumab for the treatment of macular oedema due to central retinal vein occlusion could result in substantial savings to healthcare systems and deliver similar health-related quality of life. However, patients, funders and ophthalmologists should be fully aware that LEAVO could not demonstrate that bevacizumab is non-inferior to the licensed agents.
Citation
Pennington B, Alshreef A, Flight L, Metry A, Poku E, Hykin P, Sivaprasad S, Prevost AT, Vasconcelos JC, Murphy C, Kelly J, Yang Y, Lotery A, Williams M, Brazier J. Cost Effectiveness of Ranibizumab vs Aflibercept vs Bevacizumab for the Treatment of Macular Oedema Due to Central Retinal Vein Occlusion: The LEAVO Study. Pharmacoeconomics. 2021 Apr 26. doi: 10.1007/s40273-021-01026-5. Epub ahead of print. PMID: 33900585.