A value-based medicine analysis of ranibizumab for the treatment of subfoveal neovascular macular degeneration.
OBJECTIVE
To assess the conferred value and average cost-utility (cost-effectiveness) for intravitreal ranibizumab used to treat occult/minimally classic subfoveal choroidal neovascularization associated with age-related macular degeneration (AMD).


METHODS
Value-based medicine cost-utility analysis.


METHODS
MARINA (Minimally Classic/Occult Trial of the Anti-Vascular Endothelial Growth Factor Antibody Ranibizumab in the Treatment of Neovascular AMD) Study patients utilizing published primary data.


METHODS
Reference case, third-party insurer perspective, cost-utility analysis using 2006 United States dollars.


METHODS
Conferred value in the forms of (1) quality-adjusted life-years (QALYs) and (2) percent improvement in health-related quality of life. Cost-utility is expressed in terms of dollars expended per QALY gained. All outcomes are discounted at a 3% annual rate, as recommended by the Panel on Cost-effectiveness in Health and Medicine. Data are presented for the second-eye model, first-eye model, and combined model.


RESULTS
Twenty-two intravitreal injections of 0.5 mg of ranibizumab administered over a 2-year period confer 1.039 QALYs, or a 15.8% improvement in quality of life for the 12-year period of the second-eye model reference case of occult/minimally classic age-related subfoveal choroidal neovascularization. The reference case treatment cost is $52652, and the cost-utility for the second-eye model is $50691/QALY. The quality-of-life gain from the first-eye model is 6.4% and the cost-utility is $123887, whereas the most clinically simulating combined model yields a quality-of-life gain of 10.4% and cost-utility of $74169.


CONCLUSIONS
By conventional standards and the most commonly used second-eye and combined models, intravitreal ranibizumab administered for occult/minimally classic subfoveal choroidal neovascularization is a cost-effective therapy. Ranibizumab treatment confers considerably greater value than other neovascular macular degeneration pharmaceutical therapies that have been studied in randomized clinical trials.
Brown
Melissa M
MM
Center for Value-Based Medicine, Flourtown, Pennsylvania 19031, USA. valuebasedmedicine.com
Brown
Gary C
GC
Brown
Heidi C
HC
Peet
Jonathan
J
D020533:Angiogenesis Inhibitors / Q000191:economics*; D000911:Antibodies, Monoclonal / Q000191:economics*; D061067:Antibodies, Monoclonal, Humanized; D020256:Choroidal Neovascularization / Q000188:drug therapy / Q000191:economics*; D003362:Cost-Benefit Analysis; D005584:Fovea Centralis; D006304:Health Status; D006801:Humans; D007267:Injections; D008268:Macular Degeneration / Q000188:drug therapy / Q000191:economics*; D008390:Markov Chains; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D000069579:Ranibizumab; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity; D014822:Vitreous Body
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab