贝伐单抗、雷珠单抗和阿柏西普治疗年龄相关性黄斑变性的成本效益分析——基于社会视角的成本效益分析。
The cost-effectiveness of bevacizumab, ranibizumab and aflibercept for the treatment of age-related macular degeneration-A cost-effectiveness analysis from a societal perspective.
机构信息
Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands.
Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
出版信息
PLoS One. 2018 May 17;13(5):e0197670. doi: 10.1371/journal.pone.0197670. eCollection 2018.
BACKGROUND
The discussion on the use of bevacizumab is still ongoing and often doctors are deterred from using bevacizumab due to legal or political issues. Bevacizumab is an effective, safe and inexpensive treatment option for neovascular age-related macular degeneration (AMD), albeit unregistered for the disease. Therefore, in some countries ophthalmologists use the equally effective but expensive drugs ranibizumab and aflibercept. We describe the economic consequences of this dilemma surrounding AMD treatment from a societal perspective.
METHODS
We modelled cost-effectiveness of treatment with ranibizumab (as-needed), aflibercept (bimonthly) and bevacizumab (as-needed). Effectiveness was estimated by systematic review and meta-analysis. The drug with the most favourable cost-effectiveness profile compared to bevacizumab was used for threshold analyses. First, we determined how much we overspend per injection. Second, we calculated the required effectiveness to justify the current price and the reasonable price for a drug leading to optimal vision. Finally, we estimated how much Europe overspends if bevacizumab is not first choice.
RESULTS
Bevacizumab treatment costs €27,087 per year, about €4,000 less than aflibercept and €6,000 less than ranibizumab. With similar effectiveness for all drugs as shown by meta-analysis, bevacizumab was the most cost-effective. Aflibercept was chosen for threshold analyses. Aflibercept costs €943 per injection, but we determined that the maximum price to be cost-effective is €533. Alternatively, at its current price, aflibercept should yield about twice the visual gain. Even when optimal vision can be achieved, the maximum price for any treatment is €37,453 per year. Most importantly, Europe overspends €335 million yearly on AMD treatment when choosing aflibercept over bevacizumab.
CONCLUSION
Bevacizumab is the most cost-effective treatment for AMD, yet is not the standard of care across Europe. The registered drugs ranibizumab and aflibercept lead to large overspending without additional health benefits. Health authorities should consider taking steps to implement bevacizumab into clinical practice as first choice.
背景
关于贝伐单抗的使用仍存在争议，由于法律或政治问题，医生往往不愿使用贝伐单抗。贝伐单抗是一种有效、安全且廉价的新生血管性年龄相关性黄斑变性（AMD）治疗选择，尽管该药尚未在该疾病中注册。因此，在一些国家，眼科医生使用同样有效的但更昂贵的雷珠单抗和阿柏西普。我们从社会角度描述了 AMD 治疗中这一困境的经济后果。
方法
我们从社会角度构建了雷珠单抗（按需使用）、阿柏西普（每两个月一次）和贝伐单抗（按需使用）治疗的成本效果模型。有效性通过系统评价和荟萃分析进行评估。与贝伐单抗相比，具有最有利成本效果特征的药物用于阈值分析。首先，我们确定每次注射的超额支出。其次，我们计算出需要的效果来证明目前的价格和药物的合理价格，从而实现最佳视力。最后，我们估计如果贝伐单抗不是首选药物，欧洲会多支出多少。
结果
贝伐单抗的年治疗费用为 27087 欧元，比阿柏西普低约 4000 欧元，比雷珠单抗低约 6000 欧元。荟萃分析显示所有药物的有效性相似，贝伐单抗是最具成本效果的。阿柏西普用于阈值分析。阿柏西普每次注射的费用为 943 欧元，但我们确定，具有成本效果的最高价格为 533 欧元。或者，按照目前的价格，阿柏西普的视力增益应该提高近一倍。即使可以实现最佳视力，任何治疗的最高价格也为每年 37453 欧元。最重要的是，当选择阿柏西普而不是贝伐单抗治疗 AMD 时，欧洲每年在 AMD 治疗上多支出 3.35 亿欧元。
结论
贝伐单抗是 AMD 最具成本效果的治疗药物，但在欧洲并非标准治疗方法。已注册的雷珠单抗和阿柏西普导致了大量的超额支出，而没有额外的健康益处。卫生当局应考虑采取措施，将贝伐单抗作为首选纳入临床实践。
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