title: Cost-utility of ranibizumab versus aflibercept for treating Greek patients with visual impairment due to diabetic macular edema.
abstract: BACKGROUND
  To conduct a cost-utility analysis of ranibizumab versus aflibercept for the treatment of patients with visual impairment due to diabetic macular edema (DME) in the Greek setting.
  
  
  METHODS
  A Markov model was adapted to compare the use of ranibizumab 0.5 mg (pro re nata-PRN and treat and extend-T&E) to aflibercept 2 mg (every 8 weeks after five initial doses) in DME. Patients transitioned at a 3-month cycle among nine specified health states (including death) over a lifetime horizon. Transition probabilities, utilities, as well as DME-related mortality were extracted from relevant clinical trials, a network meta-analysis and other published studies. The analysis was conducted from payer perspective and as such only costs reimbursed by the payer were considered (year 2014). The incremental cost per quality-adjusted life year (QALY) gained and the net monetary benefit was the main outcome measures.
  
  
  RESULTS
  Τhe use of PRN and T&E ranibizumab regimens were shown to be cost saving comparing to aflibercept (by €2824 and €22, respectively), and more beneficial in terms of QALYs gained (+0.05) and time without visual impairment (0.031 and 0.034 years), thereby dominating aflibercept. Moreover, ranibizumab used as PRN or T&E resulted in a net monetary benefit of €3984 and €1278, respectively.
  
  
  CONCLUSIONS
  Both PRN and T&E ranibizumab regimens were more beneficial and less costly compared to aflibercept for the management of DME. Hence, ranibizumab seems to be a dominant option for the treatment of visual impairment due to DME in the Greek setting.
authors.affiliation: EVROSTON LP, 5, Chatzigianni Mexi, 115 28 Athens, Greece.
authors.forename: Georgia
authors.initials: G
authors.lastname: Kourlaba
authors.affiliation: Department of Health Services Organization, National School of Public Health, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Relakis
authors.affiliation: Novartis Ireland Limited, Dublin, Ireland.
authors.forename: Ronan
authors.initials: R
authors.lastname: Mahon
authors.affiliation: Novartis Hellas SACI, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Kalogeropoulou
authors.affiliation: Novartis Hellas SACI, Athens, Greece.
authors.forename: Georgia
authors.initials: G
authors.lastname: Pantelopoulou
authors.affiliation: Novartis Hellas SACI, Athens, Greece.
authors.forename: Olga
authors.initials: O
authors.lastname: Kousidou
authors.affiliation: Department of Health Services Organization, National School of Public Health, Athens, Greece.
authors.forename: Nikos
authors.initials: N
authors.lastname: Maniadakis
keywords: Aflibercept; Cost-effectiveness; Diabetic macular edema; Ranibizumab