Adedokun Lola, Burke Colin
Novartis Pharmaceuticals UK Ltd, Frimley Business Park, Camberley, UK.
Novartis Ireland Limited, Dublin, Ireland.
Adv Ther. 2016 Jan;33(1):116-28. doi: 10.1007/s12325-015-0279-0. Epub 2016 Jan 8.
Ranibizumab and aflibercept are anti-vascular endothelial growth factor agents licensed for the treatment of visual impairment due to macular edema secondary to branch retinal vein occlusion (BRVO). The aim of this study was to estimate, from a UK healthcare payer's perspective, the cost-effectiveness of ranibizumab versus aflibercept in this indication.
A Markov model was used to simulate the outcomes and costs of treating BRVO. Patient baseline characteristics and efficacy data for ranibizumab were obtained from the BRAVO trial. The relative efficacy of aflibercept was derived from a published network meta-analysis. Injection frequencies were derived from ranibizumab and aflibercept studies included in the network meta-analysis. Health states were defined by increments of 10 letters in best corrected visual acuity (BCVA). Patients could gain or lose a maximum of two health states between cycles. The first cycle was 6 months, followed by monthly cycles. Different utility values were assigned to the better-seeing and worse-seeing eyes based on BCVA. A 2-year treatment time frame and a lifetime time horizon were used. Future costs and health outcomes were discounted at 3.5% per annum. Sensitivity analyses were used to test the robustness of the model.
The lifetime cost per patient treated was £15,273 with ranibizumab and £17,347 with aflibercept. Ranibizumab was dominant over aflibercept, producing incremental health gains of 0.0120 quality-adjusted life-years (QALYs) and cost savings of £2074. Net monetary benefit for ranibizumab at a willingness-to-pay threshold of £20,000/QALY was £2314. Sensitivity analyses showed that the results were robust to variations in model parameters.
Ranibizumab provides greater health gains at a lower overall cost than aflibercept in the treatment of visual impairment due to macular edema secondary to BRVO. Ranibizumab is therefore cost-effective from a UK healthcare payer's perspective.
Novartis Pharma AG, Basel, Switzerland.
雷珠单抗和阿柏西普是经许可用于治疗视网膜分支静脉阻塞（BRVO）继发黄斑水肿所致视力损害的抗血管内皮生长因子药物。本研究旨在从英国医疗保健支付方的角度评估雷珠单抗与阿柏西普在该适应症中的成本效益。
采用马尔可夫模型模拟治疗BRVO的结果和成本。雷珠单抗的患者基线特征和疗效数据来自BRAVO试验。阿柏西普的相对疗效来自已发表的网络荟萃分析。注射频率来自网络荟萃分析中纳入的雷珠单抗和阿柏西普研究。健康状态根据最佳矫正视力（BCVA）每提高10个字母来定义。患者在周期之间最多可增减两个健康状态。第一个周期为6个月，之后为每月一个周期。根据BCVA为视力较好和较差的眼睛赋予不同的效用值。采用2年的治疗时间框架和终身时间范围。未来成本和健康结果按每年3.5%进行贴现。使用敏感性分析来检验模型的稳健性。
接受雷珠单抗治疗的每位患者终身成本为15,273英镑，接受阿柏西普治疗的为17,347英镑。雷珠单抗相对于阿柏西普具有优势，产生了0.0120个质量调整生命年（QALY）的增量健康收益，并节省了2074英镑的成本。在支付意愿阈值为20,000英镑/QALY时，雷珠单抗的净货币效益为2314英镑。敏感性分析表明，结果对模型参数的变化具有稳健性。
在治疗BRVO继发黄斑水肿所致视力损害方面，雷珠单抗以较低的总体成本带来了更大的健康收益。因此，从英国医疗保健支付方的角度来看，雷珠单抗具有成本效益。
瑞士巴塞尔诺华制药公司。
