title: A United Kingdom-based economic evaluation of ranibizumab for patients with retinal vein occlusion (RVO).
abstract: OBJECTIVE
  This study compares the cost-effectiveness of intravitreal ranibizumab vs observation and/or laser photocoagulation for treatment of macular edema secondary to retinal vein occlusion in a UK-based model.
  
  
  METHODS
  A Markov model was constructed using transition probabilities and frequency of adverse events derived using data from the BRAVO, CRUISE, and HORIZON trials. Outcomes associated with treatments and health states were combined to predict overall health costs and outcomes for cohorts treated with each option.
  
  
  RESULTS
  In branch retinal vein occlusion, ranibizumab produced a gain of 0.518 quality-adjusted life years at an incremental cost of £8141, compared with laser photocoagulation. The incremental cost-effectiveness ratio was £15,710 per quality-adjusted life year, and the incremental cost per month free from blindness was £658. In central retinal vein occlusion, ranibizumab produced a gain of 0.539 quality-adjusted life years at an incremental cost of £9216, compared with observation only. The incremental cost-effectiveness ratio was £17,103, and the incremental cost per month free from blindness was £423.
  
  
  CONCLUSIONS
  These incremental cost-effectiveness ratios are below the £20,000-30,000 range typically accepted as a threshold for cost-effectiveness. This suggests that ranibizumab may be regarded as a cost-effective therapy for patients with macular edema secondary to retinal vein occlusion, relative to grid laser photocoagulation (for BRVO) and observation (for CRVO). Limitations include sparse data for utilities associated with the severity of visual impairment in the WSE in patients with RVO. A lack of direct comparative evidence between ranibizumab and the dexamethasone intravitreal implant for the treatment of BRVO and CRVO and the infeasibility of an indirect comparison due to significant heterogeneity in trial designs prevented the inclusion of this treatment as a comparator in the Markov model.
authors.affiliation: York Health Economics Consortium Ltd, University of York , York , UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Taylor
authors.forename: Elçin
authors.initials: E
authors.lastname: Serbetci
authors.forename: Alberto
authors.initials: A
authors.lastname: Ferreira
authors.forename: Kerry
authors.initials: K
authors.lastname: Gairy
authors.forename: Lily
authors.initials: L
authors.lastname: Lewis
authors.forename: Julie
authors.initials: J
authors.lastname: Blouin
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
mesh_terms: D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D017075:Laser Coagulation / Q000009:adverse effects / Q000191:economics; D008390:Markov Chains; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D000069579:Ranibizumab; D012170:Retinal Vein Occlusion / Q000188:drug therapy*; D006113:United Kingdom; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000069579:Ranibizumab
keywords: Cost-effectiveness; Macular edema; Ranibizumab; Retinal vein occlusion