title: Ranibizumab, verteporfin photodynamic therapy or observation for the treatment of myopic choroidal neovascularization: cost effectiveness in the UK.
abstract: OBJECTIVE
  The aim of this study was to evaluate the cost effectiveness of ranibizumab compared with verteporfin photodynamic therapy (vPDT) or no treatment (observation) in patients with visual impairment due to myopic choroidal neovascularization (CNV).
  
  
  METHODS
  A Markov model with health states defined by best-corrected visual acuity and a 3-month cycle length was developed. It had a healthcare provider (UK National Health Service and personal social services) perspective, a lifetime time horizon, and was based on 2011 prices; future costs and health outcomes were discounted at 3.5 % per annum. Baseline characteristics were based on the phase III RADIANCE (Ranibizumab and vPDT Evaluation in Myopic CNV) study, and year 1 health-state transitions were based on this and the VIP (Verteporfin in Photodynamic Therapy) study. Extensive sensitivity analyses tested the robustness of the model.
  
  
  RESULTS
  The lifetime cost of treating myopic CNV with ranibizumab was £12,866, whereas vPDT and observation were associated with total costs of £14,421 and £8,163, respectively. Ranibizumab treatment produced higher cumulative quality-adjusted life-years (QALYs; 12.99) than vPDT (12.60) or observation (12.45). Ranibizumab treatment was therefore dominant, with greater health gains and lower overall costs than vPDT. Ranibizumab was cost effective compared with observation, with an incremental cost-effectiveness ratio of £8,778/QALY. In the probabilistic sensitivity analysis, ranibizumab had a 100 % and 88 % probability of being cost effective compared with vPDT and observation, respectively, at a willingness-to-pay threshold of £20,000/QALY.
  
  
  CONCLUSIONS
  This study indicates that ranibizumab therapy is dominant over vPDT for the treatment of visual impairment due to CNV secondary to pathologic myopia in the UK healthcare setting and cost effective compared with observation.
authors.affiliation: York Health Economics Consortium, University of York, York, YO10 5DD, UK, lindsay.claxton@york.ac.uk.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Claxton
authors.forename: Bill
authors.initials: B
authors.lastname: Malcolm
authors.forename: Matthew
authors.initials: M
authors.lastname: Taylor
authors.forename: Jennifer
authors.initials: J
authors.lastname: Haig
authors.forename: Claudia
authors.initials: C
authors.lastname: Leteneux
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics* / Q000627:therapeutic use; D020256:Choroidal Neovascularization / Q000188:drug therapy / Q000191:economics* / Q000209:etiology; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D047728:Myopia, Degenerative / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000191:economics* / Q000627:therapeutic use; D011166:Porphyrins / Q000191:economics* / Q000627:therapeutic use; D000069579:Ranibizumab; D006113:United Kingdom; D000077362:Verteporfin
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin; D000069579:Ranibizumab