The Cost-Effectiveness of Ranibizumab for the Treatment of Diabetic Macular Edema.
OBJECTIVE
To assess the incremental, comparative effectiveness (patient value gain) and cost effectiveness (financial value gain) associated with 0.3-mg intravitreal ranibizumab injection therapy versus sham therapy for diabetic macular edema (DME).


METHODS
Value-Based Medicine (Center for Value-Based Medicine, Flourtown, PA) 14-year, cost-utility analysis using patient preferences and 2012 United States real dollars.


METHODS
Published data from the identical Ranibizumab Injection in Subjects with Clinically Significant Macular Edema with Center Involvement Secondary to Diabetes Mellitus (RISE and RIDE) clinical trials.


METHODS
An incremental cost-utility analysis was performed using societal and third-party insurer cost perspectives. Costs and outcomes were discounted with net present value analysis at 3% per annum.


METHODS
The incremental comparative effectiveness was measured in: (1) quality-adjusted life year (QALY) gain and (2) percent patient value (quality-of-life) gain. Cost effectiveness was quantified with the cost-utility ratio (CUR) measured as $/QALY.


RESULTS
The 14-year, incremental patient value gain conferred by intravitreal ranibizumab therapy for diabetic maculopathy was 0.9981 QALY, equating to an 11.6% improvement in quality of life. The direct, ophthalmic medical cost for ranibizumab therapy in 1 eye was $30 116, whereas for 2 eyes it was $56 336. The direct, nonophthalmic, medical costs saved from decreased depression, injury, skilled nursing facility admissions, nursing home admissions, and other vision-associated costs totaled $51 758, resulting in an overall direct medical cost of $4578. The net mean societal cost for bilateral ranibizumab therapy was -$30 807. Of this total, decreased caregiver costs accrued a $31 406 savings against the direct medical costs, whereas decreased wage losses accrued a $3978 savings. The third-party insurer CUR for bilateral ranibizumab therapy was $4587/QALY. The societal cost perspective for bilateral therapy was -$30 807/QALY, indicating that ranibizumab therapy dominated sham therapy because it conferred both a positive QALY gain of 0.9981 and a financial value gain (positive financial return on investment) of $30 807 referent to the direct ophthalmic medical costs expended.


CONCLUSIONS
Intravitreal ranibizumab therapy for the treatment of DME confers considerable patient (human) value gain. It also accrues financial value to patients, public and private insurers, and society.
Center for Value-Based Medicine, Flourtown, Pennsylvania; Eye Research Institute, Philadelphia, Pennsylvania; Retina Service, Wills Eye Institute, Jefferson Medical College, Philadelphia, Pennsylvania. Electronic address: gbrown@valuebasedmedicine.com.
Gary C
GC
Brown
Center for Value-Based Medicine, Flourtown, Pennsylvania; Eye Research Institute, Philadelphia, Pennsylvania; Research Department, Wills Eye Institute, Jefferson Medical College, Philadelphia, Pennsylvania.
Melissa M
MM
Brown
Healthcare Economics Unit, Genentech, Inc., South San Francisco, California.
Adam
A
Turpcu
Healthcare Economics Unit, Genentech, Inc., South San Francisco, California.
Yamina
Y
Rajput
D000368:Aged; 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; D003930:Diabetic Retinopathy / Q000188:drug therapy / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D058449:Intravitreal Injections; D008269:Macular Edema / Q000188:drug therapy / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D000069579:Ranibizumab; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000187:drug effects / Q000502:physiology
D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab