Study: Popular Treatments for Diabetic Macular Edema Not Cost-Effective
A recent study published in JAMA Ophthalmology examined the relative cost-effectiveness of aflibercept, bevacizumab, and ranibizumab for the treatment of diabetic macular edema (DME) in patients who also experienced decreased vision. Relative to bevacizumab, aflibercept and ranibizumab were not found to be cost-effective treatments for DME.
The 1-year clinical trial consisted of a total of 624 participants—209 in the aflibercept group, 207 in the bevacizumab group and 208 in the ranibizumab group—and was carried out from August 22, 2012 through August 28, 2013. Analysis was then performed from August 21, 2014 through November 7, 2015. Data from the trial was used to calculate cost-effectiveness for 1 year for the three drugs. Mathematical modeling was then used to project 10-year cost-effectiveness.
Completed analysis revealed that, for the entire group of participants, the incremental cost-effectiveness ratios (ICERs) of aflibercept and ranibizumab compared with bevacizumab were approximately $110,000 per quality-adjusted life-year (QALY) and $173,000 per QALY, respectively. The 10-year projected cost-effectivenesses were approximately $340,000 per QALY and $603,000 per QALY for aflibercept and ranibizumab, respectively, compared with bevacizumab. When compared with ranibizumab, anflibercept had ICERs of $648,000 per QALY at 1 year and $203,000 per QALY at 10 years.
A separate analysis was completed for the subgroup of participants with worse baseline vision. Results revealed the 10-year ICERs of aflibercept and ranibizumab were $287,000 per QALY and $817,000 per QALY, respectively, when compared with bevacizumab.
In order to become cost-effective and reach a threshold of $100,000 per QALY, when compared with bevacizumab during a 10-year span, the costs of aflibercept and ranibizumab would need to be decreased by 69% and 80%, respectively, the researchers found. For the subgroup of participants who experienced worse baseline vision, costs would need to decrease by roughly 62% and 84%, respectively.
The researchers concluded that, with costs approximately 31 times and 20 times more expensive than bevacizumab, respectively, aflibercept and ranibizumab are not cost-effective for the treatment of DME.
Reference:
Ross EL, Hutton DW, Stein JD, et al. Cost-effectiveness of aflibercept, bevacizumab, and ranibizumab for diabetic macular edema treatment: analysis from the Diabetic Retinopathy Clinical Research Network Comparative Effectiveness Trial [published online ahead of print June 10, 2016]. JAMA Ophthalmology. doi:10.1001/jamaophthalmol.2016.1669.
