title: The cost-effectiveness of initiating ranibizumab therapy in eyes with neovascular AMD with good vision: an economic model using real-world outcomes.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of immediate treatment with ranibizumab in patients with neovascular age-related macular degeneration (nAMD) with good (better than 6/12) starting visual acuity compared with current UK clinical guidance of waiting until vision falls below 6/12 to begin treatment, using real-world outcomes data.
  
  
  METHODS
  A patient-level health economic state transition model based on levels of visual acuity in the better seeing eye was constructed to simulate the costs and consequences of treating patients with nAMD with ranibizumab.
  
  
  METHODS
  The model took the perspective of the UK National Health Service (NHS).
  
  
  METHODS
  The model was populated with real-world outcomes and resource use from a prospective multicentre national nAMD database study containing 92,976 ranibizumab treatment episodes.
  
  
  METHODS
  Two treatment approaches were compared: immediate intervention with 0.5 mg ranibizumab pro re nata, PRN (on detection of nAMD) or delayed intervention (waiting until vision fell to 6/12 before beginning treatment).
  
  
  METHODS
  Quality-adjusted life years (QALYs) for health states and healthcare costs were accrued for each strategy, and an incremental cost-effectiveness ratio (ICER) was calculated. One-way and probabilistic sensitivity analyses were employed to test the uncertainty of the model.
  
  
  RESULTS
  Over a 2-year time horizon, based on 10,000 Monte Carlo simulations, the early treatment arm accumulated 1.59 QALYs and £8469.79 cost. The delayed treatment arm accumulated 1.35 QALYs and £7460.21 cost. The central ICER estimate was £4251.60.
  
  
  CONCLUSIONS
  A model based on real-world data is likely to be a realistic reflection of the health gains and resource use of ranibizumab for nAMD in the UK NHS. Initiating treatment immediately with ranibizumab PRN regimen is a cost-effective strategy compared with current guidance of initiating treatment at a level of 6/12 or worse vision.
authors.affiliation: Institute of Ophthalmology, University College London, London, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Butt
authors.affiliation: Moorfields Eye Hospital, London, UK.
authors.forename: Aaron
authors.initials: A
authors.lastname: Lee
authors.affiliation: Moorfields Eye Hospital, London, UK University of Washington, Seattle, WA, USA.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Lee
authors.affiliation: Institute of Ophthalmology, University College London, London, UK Moorfields Eye Hospital, London, UK.
authors.forename: Adnan
authors.initials: A
authors.lastname: Tufail
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005123:Eye / Q000473:pathology; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D009010:Monte Carlo Method; D017063:Outcome Assessment, Health Care / Q000191:economics; D010818:Practice Patterns, Physicians' / Q000191:economics; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D000069579:Ranibizumab / Q000191:economics / Q000627:therapeutic use*; D013222:State Medicine; D006113:United Kingdom; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D000069579:Ranibizumab
keywords: cost-effectiveness; electronic medical record; neovascular AMD; ranibizumab