title: Cost-effectiveness analysis of ranibizumab versus verteporfin photodynamic therapy, pegaptanib sodium, and best supportive care for the treatment of age-related macular degeneration in Greece.
abstract: BACKGROUND
  Age-related macular degeneration (AMD) is a progressive disease that results in loss of central vision, significant functional impairment, and a subsequent heavy socioeconomic burden. AMD treatments delay disease progression, improve patient outcomes, and reduce resource use associated with visual impairment, however, in a varying way concerning costs and effects.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the cost effectiveness of ranibizumab compared with verteporfin photodynamic therapy, pegaptanib sodium, and best supportive care for the treatment of AMD in Greece.
  
  
  METHODS
  A 6-state Markov model was constructed according to patient visual acuity in the better-seeing eye. Data on effectiveness were derived from randomized controlled trials evaluating the outcomes of ranibizumab versus alternative AMD treatments. Resource utilization reflected the Greek health care setting and was defined by a panel of experts. All treatments were administered for a 2-year period and evaluated during a 10-year time frame from a third-party payer perspective and discounted at 3.5% per annum.
  
  
  RESULTS
  Estimated mean 10-year direct costs of treatment in the ranibizumab arm ranged from €23,733 to €31,795 (2011 Euros), with a projected gain of 4.50 to 4.74 quality-adjusted life years (QALYs) or 2.97 to 4.47 vision years, depending on type of lesion. For predominantly classic lesions, the cost per QALY gained with ranibizumab was estimated at €6444/QALY (95% uncertainty interval [UI], €-30,403/QALY to €44,524/QALY), €15,344 (95% UI, €-11,433 to €53,554) and dominant relative to photodynamic therapy, best supportive care, and pegaptanib, respectively. Corresponding ratios for patients with minimally classic lesions were €24,580/QALY (95% UI, €-5580/QALY to €76,229/QALY) and €13,112/QALY (95% UI, €-3839/QALY to €37,527/QALY) for ranibizumab relative to best supportive care and pegaptanib, and for patients with occult lesions were estimated at €19,407/QALY (95% UI, €-1486 to €46,434) and €28,561/QALY (95% UI, €6143 to 73,431), respectively. Sensitivity analysis provided robust results in all cases.
  
  
  CONCLUSIONS
  Ranibizumab can be a cost-effective option for the treatment of AMD compared with selected alternatives in the Greek health care setting.
authors.affiliation: Department of Health Economics, National School of Public Health, Athens, Greece. kathanasakis@esdy.edu.gr
authors.forename: Kostas
authors.initials: K
authors.lastname: Athanasakis
authors.forename: Vasilios
authors.initials: V
authors.lastname: Fragoulakis
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Tsiantou
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Masaoutis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Maniadakis
authors.forename: John
authors.initials: J
authors.lastname: Kyriopoulos
mesh_terms: D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D052157:Aptamers, Nucleotide / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy*; D008390:Markov Chains; D010778:Photochemotherapy / Q000191:economics; D011166:Porphyrins / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D000069579:Ranibizumab; D000077362:Verteporfin
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide; D011166:Porphyrins; D000077362:Verteporfin; C495058:pegaptanib; D000069579:Ranibizumab