title: Aflibercept vs. Ranibizumab: cost-effectiveness of treatment for wet age-related macular degeneration in Sweden.
abstract: OBJECTIVE
  Monthly dosing with ranibizumab (RBZ) is needed to achieve maximal visual gains in patients with neovascular ('wet') age-related macular degeneration (wAMD). In Sweden, dosing is performed as needed (RBZ PRN), resulting in suboptimal efficacy. Intravitreal aflibercept (IVT-AFL) every 2 months after three initial monthly doses was clinically equivalent to RBZ monthly dosing (RBZ q4) in wAMD clinical trials. We assessed the cost-effectiveness of IVT-AFL versus RBZ q4 and RBZ PRN in Sweden.
  
  
  METHODS
  A Markov model compared IVT-AFL to RBZ q4 or RBZ PRN over 2 years. Health states were based on visual acuity in better-seeing eye; a proportion discontinued treatment monthly or upon visual acuity <20/400. Parameters were estimated from trial data, published literature or expert opinion. Analyses were performed from a societal perspective with a lifetime horizon. The model calculated costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs), discounted 3% annually. Deterministic and probabilistic sensitivity analyses were performed.
  
  
  RESULTS
  Lifetime cost of IVT-AFL was 578 400 SEK, compared with 565 700 SEK for RBZ PRN and 686 600 SEK for RBZ q4. Compared with RBZ PRN, the ICER of IVT-AFL was 27 000 SEK/QALY gained. RBZ q4 cost 20.4 million SEK/QALY gained versus IVT-AFL. Results were sensitive to IVT-AFL efficacy, but IVT-AFL had a 100% probability of being cost-effective versus both RBZ PRN and RBZ q4 at a willingness-to-pay threshold of 500 000 SEK.
  
  
  CONCLUSIONS
  Results suggest, in Sweden, at parity price level, IVT-AFL is less costly than RBZ q4, while demonstrating similar efficacy; IVT-AFL is cost-effective versus RBZ PRN.
authors.affiliation: Optum, Waltham, Massachusetts, USA.
authors.forename: Hemangi R
authors.initials: HR
authors.lastname: Panchmatia
authors.affiliation: Optum, Waltham, Massachusetts, USA.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Clements
authors.affiliation: Optum, Eden Prairie, Minnesota, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Hulbert
authors.affiliation: Bayer AB, Solna, Sweden.
authors.forename: Marianne
authors.initials: M
authors.lastname: Eriksson
authors.affiliation: Bayer Pharma AG, Berlin, Germany.
authors.forename: Kim
authors.initials: K
authors.lastname: Wittrup-Jensen
authors.affiliation: Optum, Stockholm, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Nilsson
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts, USA.|Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
authors.forename: Milton C
authors.initials: MC
authors.lastname: Weinstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D015233:Models, Statistical; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D000069579:Ranibizumab / Q000008:administration & dosage / Q000191:economics*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage / Q000191:economics*; D013548:Sweden; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000187:drug effects; D057135:Wet Macular Degeneration / Q000188:drug therapy / Q000191:economics*
chemical_list: D020533:Angiogenesis Inhibitors; D011993:Recombinant Fusion Proteins; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab
keywords: Markov model; aflibercept; cost-effectiveness; wAMD