Raftery James, Clegg Andrew, Jones Jeremy, Tan Seng Chuen, Lotery Andrew
Wessex Institute for Health R&D, Medical School, University of Southampton, Southampton, UK.
Br J Ophthalmol. 2007 Sep;91(9):1244-6. doi: 10.1136/bjo.2007.116616. Epub 2007 Apr 12.
Two new drugs provide startling benefits in the treatment of age-related macular degeneration (AMD). The clinical and cost effectiveness of ranibizumab (Lucentis) was compared to that of bevacizumab (Avastin), which costs up to 100 times less. A cost effectiveness model was developed to assess the cost per quality adjusted life year (QALY) over 10 years. For predominantly classic AMD, the efficacy of bevacizumab relative to ranibizumab would have to be around 40% for the latter to achieve 30 k pounds per QALY, a NICE threshold. Similar but worse results applied to the other main forms of AMD, minimally occult and occult with no classic lesions. The price of ranibizumab would have to be drastically reduced for it to be cost effective. Continued unlicensed use of bevacizumab raises ethical, legal and policy questions. Public pressure may be the most potent weapon in persuading Genentech to license bevacizumab for AMD.
两种新药在治疗年龄相关性黄斑变性（AMD）方面带来了惊人的益处。将雷珠单抗（Lucentis）与贝伐单抗（Avastin）的临床效果和成本效益进行了比较，后者的成本低至前者的1/100。开发了一个成本效益模型，以评估10年内每质量调整生命年（QALY）的成本。对于主要为典型性AMD的患者，若雷珠单抗要达到每QALY 30000英镑这一英国国家卫生与临床优化研究所（NICE）的阈值，贝伐单抗相对于雷珠单抗的疗效必须达到约40%。类似但更差的结果适用于AMD的其他主要类型，即微小隐匿性和隐匿性且无典型病变。雷珠单抗的价格必须大幅降低才能具有成本效益。继续未经许可使用贝伐单抗引发了伦理、法律和政策问题。公众压力可能是说服基因泰克公司批准贝伐单抗用于治疗AMD的最有力武器。
