Chen Rui, Wu Bin
Department of Ophthalmology, The Second People's Hospital of Foshan, Foshan, China.
Medical Decision and Economic Group, Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Ann Transl Med. 2020 Aug;8(15):939. doi: 10.21037/atm-20-1334.
The potential benefits of conbercept, aflibercept, and ranibizumab has been reported in patients with wet age-related macular degeneration (wAMD). However, their economic outcomes are still unclear. The current study would assess the cost-effectiveness of conbercept, aflibercept and ranibizumab for patients with wAMD in a Chinese healthcare setting.
A Markov model was constructed based on patient visual acuity. Five regimens were considered: usual care without active anti-vascular endothelial growth factor (VEGF) treatment, IVT-AFL (intravitreal aflibercept on a two-monthly basis following three initial monthly doses), RBZ q4 (ranibizumab monthly dosing), RBZ RPN (ranibizumab dose as needed) and IVT-CON (intravitreal conbercept on a three-monthly basis after three initial monthly doses). Clinical, cost, and utility data were collected from published literature.
In comparison with usual care, the IVT-AFL, RBZ q4, RBZ PRN, and IVT-CON strategies provided an additional 0.235, 0.338, 0.228, and 0.324 quality-adjusted life years (QALYs), respectively. They had marginal costs of $6,800, $10,084, $4,640, and $6,173, respectively. The strategies also produced incremental cost-effectiveness ratios (ICERs) of $28,892, $29,857, $20,338 and $19,028/QALY, respectively. One-way sensitivity analysis showed utility of blindness (best-corrected visual acuity <35) to have the greatest sensitivity of all the parameters. Probabilistic sensitivity analysis (PSA) indicated that IVT-CON yielded the greatest probabilities of cost-effectiveness (about 92%) compared with other strategies.
Conbercept is a cost-effective option for the treatment of wAMD in a Chinese healthcare setting.
在湿性年龄相关性黄斑变性(wAMD)患者中,已报道了康柏西普、阿柏西普和雷珠单抗的潜在益处。然而,它们的经济效果仍不明确。本研究将评估在中国医疗环境中,康柏西普、阿柏西普和雷珠单抗治疗wAMD患者的成本效益。
基于患者视力构建马尔可夫模型。考虑了五种治疗方案:不进行积极抗血管内皮生长因子(VEGF)治疗的常规护理、IVT-AFL(在最初每月给药三次后每两个月一次玻璃体内注射阿柏西普)、RBZ q4(雷珠单抗每月给药)、RBZ RPN(按需使用雷珠单抗剂量)和IVT-CON(在最初每月给药三次后每三个月一次玻璃体内注射康柏西普)。从已发表的文献中收集临床、成本和效用数据。
与常规护理相比,IVT-AFL、RBZ q4、RBZ PRN和IVT-CON策略分别额外提供了0.235、0.338、0.228和0.324个质量调整生命年(QALY)。它们的边际成本分别为6800美元、10084美元、4640美元和6173美元。这些策略还分别产生了每QALY 28892美元、29857美元、20338美元和19028美元的增量成本效益比(ICER)。单向敏感性分析表明,失明效用(最佳矫正视力<35)在所有参数中敏感性最高。概率敏感性分析(PSA)表明,与其他策略相比,IVT-CON产生成本效益的概率最高(约92%)。
在中国医疗环境中,康柏西普是治疗wAMD的一种具有成本效益的选择。