Cost-effectiveness of ranibizumab and bevacizumab for age-related macular degeneration: 2-year findings from the IVAN randomised trial.
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.
Affiliation: Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK.Show MeSH
Related in: MedlinePlus
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.
Affiliation: Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK.