title: Cost-effectiveness of ranibizumab in treatment of diabetic macular oedema (DME) causing visual impairment: evidence from the RESTORE trial.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of ranibizumab as either monotherapy or combined with laser therapy, compared with laser monotherapy, in the treatment of diabetic macular oedema (DME) causing visual impairment from a UK healthcare payer perspective.
  
  
  METHODS
  A Markov model simulated long-term outcomes and costs of treating DME in one eye (BCVA ≤75 letters) based on data from the RESTORE Phase III trial. Outcomes measured in quality-adjusted life-years (QALYs) were simulated for a 15-year time horizon based on 12-month follow-up from RESTORE and published long-term data. Costs included treatment, disease monitoring, visual impairment and blindness (at 2010 price levels).
  
  
  RESULTS
  Ranibizumab monotherapy resulted in a 0.17 QALY gain at an incremental cost of £4191 relative to laser monotherapy, yielding an incremental cost-effectiveness ratio (ICER) of £24 028. Probabilistic sensitivity analysis showed a 64% probability of being cost-effective at a threshold of £30 000 per QALY. Combined ranibizumab and laser therapy resulted in a 0.13 QALY gain at an incremental cost of £4695 relative to laser monotherapy (ICER £36 106; 42% probability of ICER <£30 000).
  
  
  CONCLUSIONS
  Based on RESTORE 1-year follow-up data, ranibizumab monotherapy appears to be cost-effective relative to laser monotherapy, the current standard of care. Cost-effectiveness of combination therapy is less certain. Ongoing studies will further inform on disease progression and the need for additional ranibizumab treatment.
authors.affiliation: Centre for Vision Research, Westmead Millennium Institute, Westmead Hospital, Hawkesbury Rd, Westmead, 2145 Australia. paul.mitchell@sydney.edu.au
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
authors.forename: Lieven
authors.initials: L
authors.lastname: Annemans
authors.forename: Meghan
authors.initials: M
authors.lastname: Gallagher
authors.forename: Rafiq
authors.initials: R
authors.lastname: Hasan
authors.forename: Simu
authors.initials: S
authors.lastname: Thomas
authors.forename: Kerry
authors.initials: K
authors.lastname: Gairy
authors.forename: Martin
authors.initials: M
authors.lastname: Knudsen
authors.forename: Henrietta
authors.initials: H
authors.lastname: Onwordi
mesh_terms: D020533:Angiogenesis Inhibitors / Q000191:economics*; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics*; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D003930:Diabetic Retinopathy / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D016527:Drug Costs; D006801:Humans; D017075:Laser Coagulation; D008269:Macular Edema / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D000069579:Ranibizumab; D006113:United Kingdom; D014786:Vision Disorders / Q000191:economics* / Q000209:etiology; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000069579:Ranibizumab