title: The comparative effectiveness and cost-effectiveness of ranibizumab for neovascular macular degeneration revisited.
abstract: BACKGROUND
  To compare a near decade of follow-up, newer control cohort data, use of both the societal and third party insurer cost perspectives, and integration of unilateral/bilateral therapy on the comparative effectiveness and cost-effectiveness of intravitreal ranibizumab therapy for neovascular, age-related macular degeneration (AMD).
  
  
  METHODS
  Value-Based Medicine®, 12-year, combined-eye model, cost-utility analysis employing MARINA and HORIZON clinical trial data. Preference-based comparative effectiveness outcomes were quantified in (1) QALY (quality-adjusted life-year) gain, and (2) percent improvement in quality-of-life, while cost-effectiveness outcomes were quantified in (3) the cost-utility ratio (CUR) and financial return-on-investment (ROI) to society.
  
  
  RESULTS
  Using MARINA and HORIZON trial data and a meta-analysis control cohort after 24 months, ranibizumab therapy conferred a combined-eye patient value (quality-of-life) gain of 16.3%, versus 10.4% found in 2006. The two-year direct ophthalmic medical cost for ranibizumab therapy was $46,450, a 33.8% real dollar decrease from 2006. The societal cost perspective CUR was -$242,920/QALY, indicating a $282,517 financial return-on-investment (ROI), or 12.3%/year to society for direct ophthalmic medical costs expended. The 3rd party insurer CUR ranged from $21,199/QALY utilizing all direct, medical costs, to $69,591/QALY using direct ophthalmic medical costs.
  
  
  CONCLUSIONS
  Ranibizumab therapy for neovascular AMD in 2015, considering treatment of both eyes, conferred greater patient value gain (comparative effectiveness) and improved cost-effectiveness than in 2006, as well as a large monetary return-on-investment to the Gross Domestic Product and nation's wealth. The model herein integrates important novel features for neovascular age-related macular degeneration, vitreoretinal cost effectiveness analyses, including: (1) treatment of both eyes, (2) a long-term, untreated control cohort, and (3) the use of societal costs.
authors.affiliation: The Center for Value-Based Medicine®, Box 6181, Hilton Head, SC 29938 USA ; The Eye Research Institute, Philadelphia, PA USA ; The Retina Service, Wills Eye Institute, Jefferson Medical College, Philadelphia, PA USA ; The Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA USA.
authors.forename: Gary C
authors.identifier: 0000-0002-1201-7075
authors.initials: GC
authors.lastname: Brown
authors.affiliation: The Center for Value-Based Medicine®, Box 6181, Hilton Head, SC 29938 USA ; The Eye Research Institute, Philadelphia, PA USA ; The Research Department, Wills Eye Institute, Jefferson Medical College, Philadelphia, PA USA ; The Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA USA.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Brown
authors.affiliation: The Center for Value-Based Medicine®, Box 6181, Hilton Head, SC 29938 USA.
authors.forename: Heidi B
authors.initials: HB
authors.lastname: Lieske
authors.affiliation: The Healthcare Economics Unit, Genentech, Inc., South San Francisco, CA USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Turpcu
authors.affiliation: The Healthcare Economics Unit, Genentech, Inc., South San Francisco, CA USA.
authors.forename: Yamina
authors.initials: Y
authors.lastname: Rajput
keywords: Age-related macular degeneration; Clinical cost-utility model; Cost-utility analysis; Ranibizumab