title: The Cost-Effectiveness of Ranibizumab Treat and Extend Regimen Versus Aflibercept in the UK.
abstract: Wet age-related macular degeneration (AMD) is a chronic eye condition that causes severe deterioration of vision and even blindness. Current wet AMD treatment in the UK involves the vascular endothelial growth factor inhibitors ranibizumab and aflibercept. Patients with wet AMD require frequent and long-term monitoring for treatment to be effective, contributing to a substantial resource burden at wet AMD centers. The European license for ranibizumab was recently updated with an individualized 'treat and extend' (T&E) regimen, comprising a structured monitoring and treatment protocol. This study evaluated the cost-effectiveness of ranibizumab T&E versus aflibercept within a UK setting.
  
  
  
  An individual patient-level simulation model was developed utilizing treatment effects from a network meta-analysis of randomized controlled trials. The model was conducted from a UK National Health Service (NHS) perspective over a lifetime horizon and the base case utilized probabilistic sensitivity analysis to assess uncertainty in the model. Additional scenario analyses were conducted to assess the impact of changes to the model inputs.
  
  
  
  Ranibizumab T&E was found to be more effective and less costly than aflibercept, providing, on average, an additional 1.058 quality-adjusted life years (QALYs) and a cost-saving of £19,604 over a lifetime horizon. At list price, ranibizumab T&E was found to be cost-effective versus aflibercept in 100% of simulations at a willingness-to-pay threshold of £20,000 per QALY. The robustness of the results was tested in several scenario analyses; ranibizumab T&E was found to be more effective, and less costly, than aflibercept in the vast majority of cases.
  
  
  
  This evaluation suggests that treating patients with ranibizumab according to the T&E regimen could be a better use of NHS resources than aflibercept, and could, therefore, be considered as a first-line regimen for patients with wet AMD in the UK.
  
  
  
  Novartis Pharmaceuticals UK Limited.
authors.affiliation: Costello Medical Consulting Ltd., Cambridge, UK.
authors.forename: Wrik
authors.initials: W
authors.lastname: Ghosh
authors.affiliation: Costello Medical Consulting Ltd., Cambridge, UK.
authors.forename: Rose
authors.initials: R
authors.lastname: Wickstead
authors.affiliation: York Health Economics Consortium, University of York, York, UK.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Claxton
authors.affiliation: Costello Medical Consulting Ltd., Cambridge, UK.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Kusel
authors.affiliation: York Health Economics Consortium, University of York, York, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Taylor
authors.affiliation: Quantics, Edinburgh, UK.
authors.forename: Kelly
authors.initials: K
authors.lastname: Fleetwood
authors.affiliation: Novartis Pharmaceuticals UK Limited, Surrey, UK. Ruth.jacob@novartis.com.
authors.forename: Ruth
authors.initials: R
authors.lastname: Pulikottil-Jacob
mesh_terms: D000368:Aged; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D006801:Humans; D058449:Intravitreal Injections; D008134:Long-Term Care / Q000191:economics* / Q000379:methods; D009885:Ophthalmology / Q000191:economics; D019057:Quality-Adjusted Life Years; D000069579:Ranibizumab / Q000191:economics* / Q000627:therapeutic use; D040262:Receptors, Vascular Endothelial Growth Factor / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000191:economics* / Q000627:therapeutic use; D006113:United Kingdom; D057135:Wet Macular Degeneration / Q000188:drug therapy / Q000191:economics
chemical_list: D011993:Recombinant Fusion Proteins; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab
keywords: Aflibercept; Age-related macular degeneration; Cost-effectiveness; Ophthalmology; Ranibizumab; Treat and extend