Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan.
Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan.
Ophthalmology. 2014 Apr;121(4):936-45. doi: 10.1016/j.ophtha.2013.10.037. Epub 2014 Jan 7.
We sought to determine the most cost-effective treatment for patients with newly diagnosed neovascular macular degeneration: monthly or as-needed bevacizumab injections, or monthly or as-needed ranibizumab injections.
Cost-effectiveness analysis.
Hypothetical cohort of 80-year-old patients with newly diagnosed neovascular macular degeneration.
Using a mathematical model with a 20-year time horizon, we compared the incremental cost-effectiveness of treating a hypothetical cohort of 80-year-old patients with newly diagnosed neovascular macular degeneration using monthly bevacizumab, as-needed bevacizumab, monthly ranibizumab, or as-needed ranibizumab. Data came from the Comparison of Age-related macular degeneration Treatment Trial (CATT), the Medicare Fee Schedule, and the medical literature.
Costs, quality-adjusted life-years (QALYs), and incremental costs per QALY gained.
Compared with as-needed bevacizumab, the incremental cost-effectiveness ratio of monthly bevacizumab is $24,2 357/QALY. Monthly ranibizumab gains an additional 0.02 QALYs versus monthly bevacizumab at an incremental cost-effectiveness ratio of >$10 million/QALY. As-needed ranibizumab was dominated by monthly bevacizumab, meaning it was more costly and less effective. In sensitivity analyses assuming a willingness to pay of $100,000/QALY, the annual risk of serious vascular events would have to be ≥2.5 times higher with bevacizumab than that observed in the CATT trial for as-needed ranibizumab to have an incremental cost-effectiveness ratio of <$100,000/QALY. In another sensitivity analysis, even if every patient receiving bevacizumab experienced declining vision by 1 category (e.g., from 20/25-20/40 to 20/50-20/80) after 2 years but every patient receiving ranibizumab retained their vision level, as-needed ranibizumab would have an incremental cost-effectiveness ratio of $97,340/QALY.
Even after considering the potential for differences in risks of serious adverse events and therapeutic effectiveness, bevacizumab confers considerably greater value than ranibizumab for the treatment of neovascular macular degeneration.
我们旨在确定治疗新发湿性年龄相关性黄斑变性患者的最具成本效益的治疗方法：每月或按需给予贝伐单抗注射，或每月或按需给予雷珠单抗注射。
成本效益分析。
患有新发湿性年龄相关性黄斑变性的 80 岁假设队列患者。
使用具有 20 年时间范围的数学模型，我们比较了每月给予贝伐单抗、按需给予贝伐单抗、每月给予雷珠单抗或按需给予雷珠单抗治疗假设 80 岁新发湿性年龄相关性黄斑变性队列患者的增量成本效益。数据来自年龄相关性黄斑变性治疗比较试验（CATT）、医疗保险费用表和医学文献。
成本、质量调整生命年（QALY）和每获得一个 QALY 的增量成本。
与按需给予贝伐单抗相比，每月给予贝伐单抗的增量成本效益比为 24,2357 美元/QALY。每月雷珠单抗与每月贝伐单抗相比，可额外增加 0.02 QALY，增量成本效益比大于 1000 万美元/QALY。按需给予雷珠单抗优于每月贝伐单抗，即成本更高，效果更差。在假设支付意愿为 10 万美元/QALY 的敏感性分析中，贝伐单抗的严重血管事件年风险必须比 CATT 试验中按需给予雷珠单抗高 2.5 倍以上，才能使按需给予雷珠单抗的增量成本效益比低于 10 万美元/QALY。在另一项敏感性分析中，即使每例接受贝伐单抗治疗的患者在 2 年后视力下降 1 个等级（例如，从 20/25-20/40 降至 20/50-20/80），但每例接受雷珠单抗治疗的患者保留其视力水平，按需给予雷珠单抗的增量成本效益比仍为 97340 美元/QALY。
即使考虑到严重不良事件风险和治疗效果的潜在差异，贝伐单抗在治疗湿性年龄相关性黄斑变性方面也比雷珠单抗具有更大的价值。
