Limits...
Cost-effectiveness of ranibizumab and bevacizumab for age-related macular degeneration: 2-year findings from the IVAN randomised trial.

Dakin HA, Wordsworth S, Rogers CA, Abangma G, Raftery J, Harding SP, Lotery AJ, Downes SM, Chakravarthy U, Reeves BC, IVAN Study Investigato - BMJ Open (2014)

Bottom Line: Continuous ranibizumab would only be cost-effective compared with continuous bevacizumab if the NHS were willing to pay £3.5 million ($5.5 million) per additional QALY gained.However, bootstrapping demonstrated that if the NHS is willing to pay £20 000/QALY gained, there is a 37% chance that continuous bevacizumab is cost-effective versus discontinuous bevacizumab.Ranibizumab is not cost-effective compared with bevacizumab, being substantially more costly and producing little or no QALY gain.

View Article: PubMed Central - PubMed

Affiliation: Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK.

Show MeSH

Related in: MedlinePlus

Cost-effectiveness acceptability curve showing the probability that each treatment is the most cost-effective strategy evaluated in the UK Inhibition of VEGF in Age-related choroidal Neovascularisation trial at a range of ceiling ratios. For example, at a ceiling ratio of £20 000/quality-adjusted life-year (QALY) gained (shown by the vertical dashed line), there is a 63% probability that discontinuous bevacizumab is best and a 37% probability that continuous bevacizumab is best, while the probability that either ranibizumab treatment regimen is best is approximately 0% (total=100%).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4120317&req=5

BMJOPEN2014005094F2: Cost-effectiveness acceptability curve showing the probability that each treatment is the most cost-effective strategy evaluated in the UK Inhibition of VEGF in Age-related choroidal Neovascularisation trial at a range of ceiling ratios. For example, at a ceiling ratio of £20 000/quality-adjusted life-year (QALY) gained (shown by the vertical dashed line), there is a 63% probability that discontinuous bevacizumab is best and a 37% probability that continuous bevacizumab is best, while the probability that either ranibizumab treatment regimen is best is approximately 0% (total=100%).

Mentions: However, there remains substantial uncertainty around incremental QALY gains. This is illustrated by the cost-effectiveness acceptability curves plotting the probability of each treatment being the most cost-effective of the four strategies at different ceiling ratios (figure 2). This demonstrates that although we can be 98% confident that discontinuous bevacizumab is less costly than continuous bevacizumab, our confidence in the conclusion that discontinuous bevacizumab has the highest net benefits decreases rapidly as the value we place on the small, non-significant QALY gains increases. At a £20 000/QALY ceiling ratio, there is a 63% probability that discontinuous bevacizumab is the most cost-effective strategy considered in IVAN and a 37% probability that continuous bevacizumab is the most cost-effective. In contrast, the probability of either continuous or discontinuous ranibizumab being the most cost-effective strategy for managing nAMD is <1% unless the NHS were willing to pay more than £100 000/QALY gained.


Cost-effectiveness of ranibizumab and bevacizumab for age-related macular degeneration: 2-year findings from the IVAN randomised trial.

Dakin HA, Wordsworth S, Rogers CA, Abangma G, Raftery J, Harding SP, Lotery AJ, Downes SM, Chakravarthy U, Reeves BC, IVAN Study Investigato - BMJ Open (2014)

Cost-effectiveness acceptability curve showing the probability that each treatment is the most cost-effective strategy evaluated in the UK Inhibition of VEGF in Age-related choroidal Neovascularisation trial at a range of ceiling ratios. For example, at a ceiling ratio of £20 000/quality-adjusted life-year (QALY) gained (shown by the vertical dashed line), there is a 63% probability that discontinuous bevacizumab is best and a 37% probability that continuous bevacizumab is best, while the probability that either ranibizumab treatment regimen is best is approximately 0% (total=100%).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4120317&req=5

BMJOPEN2014005094F2: Cost-effectiveness acceptability curve showing the probability that each treatment is the most cost-effective strategy evaluated in the UK Inhibition of VEGF in Age-related choroidal Neovascularisation trial at a range of ceiling ratios. For example, at a ceiling ratio of £20 000/quality-adjusted life-year (QALY) gained (shown by the vertical dashed line), there is a 63% probability that discontinuous bevacizumab is best and a 37% probability that continuous bevacizumab is best, while the probability that either ranibizumab treatment regimen is best is approximately 0% (total=100%).
Mentions: However, there remains substantial uncertainty around incremental QALY gains. This is illustrated by the cost-effectiveness acceptability curves plotting the probability of each treatment being the most cost-effective of the four strategies at different ceiling ratios (figure 2). This demonstrates that although we can be 98% confident that discontinuous bevacizumab is less costly than continuous bevacizumab, our confidence in the conclusion that discontinuous bevacizumab has the highest net benefits decreases rapidly as the value we place on the small, non-significant QALY gains increases. At a £20 000/QALY ceiling ratio, there is a 63% probability that discontinuous bevacizumab is the most cost-effective strategy considered in IVAN and a 37% probability that continuous bevacizumab is the most cost-effective. In contrast, the probability of either continuous or discontinuous ranibizumab being the most cost-effective strategy for managing nAMD is <1% unless the NHS were willing to pay more than £100 000/QALY gained.

Bottom Line: Continuous ranibizumab would only be cost-effective compared with continuous bevacizumab if the NHS were willing to pay £3.5 million ($5.5 million) per additional QALY gained.However, bootstrapping demonstrated that if the NHS is willing to pay £20 000/QALY gained, there is a 37% chance that continuous bevacizumab is cost-effective versus discontinuous bevacizumab.Ranibizumab is not cost-effective compared with bevacizumab, being substantially more costly and producing little or no QALY gain.

View Article: PubMed Central - PubMed

Affiliation: Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK.

Show MeSH
Related in: MedlinePlus