title: Cost-effectiveness of bevacizumab and ranibizumab for newly diagnosed neovascular macular degeneration (an American Ophthalmological Society thesis).
abstract: OBJECTIVE
  To determine the most cost-effective treatment for patients with newly diagnosed neovascular macular degeneration: monthly or as-needed bevacizumab injections, or monthly or as-needed ranibizumab injections.
  
  
  METHODS
  Using a Markov model with a 20-year time horizon, we compared the incremental cost-effectiveness of treating a hypothetical cohort of 80-year-old patients with newly diagnosed neovascular macular degeneration using monthly bevacizumab, as-needed bevacizumab, monthly ranibizumab, or as-needed ranibizumab. Data came from the Comparison of Age-Related Macular Degeneration Treatment Trial (CATT), the Medicare Fee Schedules, and the medical literature.
  
  
  RESULTS
  Compared with as-needed bevacizumab, the incremental cost-effectiveness ratio of monthly bevacizumab is $242,357 per quality-adjusted life year (QALY). Monthly ranibizumab gains an additional 0.02 QALYs vs monthly bevacizumab at an incremental cost-effectiveness ratio of more than $10 million per QALY. As-needed ranibizumab was dominated by monthly bevacizumab. In sensitivity analyses assuming a willingness to pay of $100,000 per QALY, the annual risk of serious vascular events would have to be at least 2.5 times higher with bevacizumab than that observed in the CATT trial for as-needed ranibizumab to have an incremental cost-effectiveness ratio of <$100,000 per QALY. In another sensitivity analysis, even if every patient receiving bevacizumab experienced declining vision by one category (eg, from 20/25-20/40 to 20/50-20/80) after 2 years but all patients receiving ranibizumab retained their vision level, as-needed ranibizumab would have an incremental cost-effectiveness ratio of $97,340 per QALY.
  
  
  CONCLUSIONS
  Even after considering the potential for differences in risks of serious adverse events and therapeutic effectiveness, bevacizumab confers considerably greater value than ranibizumab for the treatment of neovascular macular degeneration.
authors.affiliation: Department of Ophthalmology and Visual Sciences (Dr Stein, Dr Newman-Casey, Dr Lee) and the Department of Health Management and Policy (Ms Mrinalini, Dr Hutton), University of Michigan, Ann Arbor.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Stein
authors.forename: Paula Anne
authors.initials: PA
authors.lastname: Newman-Casey
authors.forename: Tavag
authors.initials: T
authors.lastname: Mrinalini
authors.forename: Paul P
authors.initials: PP
authors.lastname: Lee
authors.forename: David W
authors.initials: DW
authors.lastname: Hutton
mesh_terms: D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000191:economics / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics / Q000627:therapeutic use*; D000068258:Bevacizumab; D020256:Choroidal Neovascularization / Q000188:drug therapy* / Q000191:economics; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy* / Q000191:economics; D008390:Markov Chains; D008962:Models, Theoretical; D019057:Quality-Adjusted Life Years; D000069579:Ranibizumab; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D000069579:Ranibizumab