title: Cost-Effectiveness of Ranibizumab Versus Aflibercept for Macular Edema Secondary to Branch Retinal Vein Occlusion: A UK Healthcare Perspective.
abstract: BACKGROUND
  Ranibizumab and aflibercept are anti-vascular endothelial growth factor agents licensed for the treatment of visual impairment due to macular edema secondary to branch retinal vein occlusion (BRVO). The aim of this study was to estimate, from a UK healthcare payer's perspective, the cost-effectiveness of ranibizumab versus aflibercept in this indication.
  
  
  METHODS
  A Markov model was used to simulate the outcomes and costs of treating BRVO. Patient baseline characteristics and efficacy data for ranibizumab were obtained from the BRAVO trial. The relative efficacy of aflibercept was derived from a published network meta-analysis. Injection frequencies were derived from ranibizumab and aflibercept studies included in the network meta-analysis. Health states were defined by increments of 10 letters in best corrected visual acuity (BCVA). Patients could gain or lose a maximum of two health states between cycles. The first cycle was 6 months, followed by monthly cycles. Different utility values were assigned to the better-seeing and worse-seeing eyes based on BCVA. A 2-year treatment time frame and a lifetime time horizon were used. Future costs and health outcomes were discounted at 3.5% per annum. Sensitivity analyses were used to test the robustness of the model.
  
  
  RESULTS
  The lifetime cost per patient treated was £15,273 with ranibizumab and £17,347 with aflibercept. Ranibizumab was dominant over aflibercept, producing incremental health gains of 0.0120 quality-adjusted life-years (QALYs) and cost savings of £2074. Net monetary benefit for ranibizumab at a willingness-to-pay threshold of £20,000/QALY was £2314. Sensitivity analyses showed that the results were robust to variations in model parameters.
  
  
  CONCLUSIONS
  Ranibizumab provides greater health gains at a lower overall cost than aflibercept in the treatment of visual impairment due to macular edema secondary to BRVO. Ranibizumab is therefore cost-effective from a UK healthcare payer's perspective.
  
  
  BACKGROUND
  Novartis Pharma AG, Basel, Switzerland.
authors.affiliation: Novartis Pharmaceuticals UK Ltd, Frimley Business Park, Camberley, UK. lola.adedokun@novartis.com.
authors.forename: Lola
authors.initials: L
authors.lastname: Adedokun
authors.affiliation: Novartis Ireland Limited, Dublin, Ireland.
authors.forename: Colin
authors.initials: C
authors.lastname: Burke
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008269:Macular Edema / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D019057:Quality-Adjusted Life Years; D000069579:Ranibizumab / Q000191:economics* / Q000627:therapeutic use*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000191:economics* / Q000627:therapeutic use*; D011993:Recombinant Fusion Proteins / Q000191:economics* / Q000627:therapeutic use*; D012170:Retinal Vein Occlusion / Q000150:complications; D013557:Switzerland; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity
chemical_list: D011993:Recombinant Fusion Proteins; D042461:Vascular Endothelial Growth Factor A; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab
keywords: Aflibercept; Branch retinal vein occlusion; Cost-effectiveness; Markov model; Ophthalmology; Ranibizumab; Retina