Ranibizumab (Lucentis) versus bevacizumab (Avastin): modelling cost effectiveness.
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.
Raftery
James
J
Wessex Institute for Health R&D, Medical School, University of Southampton, Southampton, UK. raftery@soton.ac.uk
Clegg
Andrew
A
Jones
Jeremy
J
Tan
Seng Chuen
SC
Lotery
Andrew
A
D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology; D008390:Markov Chains; D017059:Models, Econometric; D019057:Quality-Adjusted Life Years; D000069579:Ranibizumab; D016896:Treatment Outcome; D014792:Visual Acuity
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D000069579:Ranibizumab