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Analysis: Eylea, Lucentis less cost-effective than Avastin for treatment of DME
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Aflibercept and ranibizumab were less cost-effective than bevacizumab in the treatment of diabetic macular edema, according to a post hoc analysis of data from the Diabetic Retinopathy Clinical Research Network Protocol T trial.
“These results highlight the challenges that physicians, patients and policymakers face when safety and efficacy results are at odds with cost-effectiveness results,” the study authors said.
The analysis included 624 patients randomized to Eylea (aflibercept, Regeneron), Avastin (bevacizumab, Genentech) or Lucentis (ranibizumab, Genentech).
Based on 2015 wholesale acquisition costs, the cost of aflibercept 2 mg was $1,850, ranibizumab 0.3 mg $1,170 and repackaged 1.25 mg bevacizumab about $60 per dose.
Investigators calculated incremental cost-effectiveness ratios (ICERs) for aflibercept, bevacizumab and ranibizumab for 1 year and then projected 10-year results. ICERs were calculated for participants and subgroups with baseline visual acuity of 20/32 to 20/40 and 20/50 or worse.
Over 1 year for all patients, the ICER of aflibercept compared with bevacizumab was $1.11 million per quality-adjusted life-year (QALY), and the ICER of ranibizumab compared with bevacizumab was $1.73 million per QALY.
Over 10 years for all patients, the ICER of aflibercept compared with bevacizumab was $349,000 per QALY, and the ICER of ranibizumab compared with bevacizumab was $603,000 per QALY.
“In eyes with decreased vision from DME, treatment costs of aflibercept and ranibizumab would need to decrease by 69% and 80%, respectively, to reach a cost-effectiveness threshold of $100,000 per QALY compared with bevacizumab during a 10-year horizon; for the subgroup with worse baseline vision, the costs would need to decrease by 62% and 84%, respectively,” the study authors said. – by Matt Hasson
Disclosure: Ross reports no relevant financial disclosures. See the full study for all other authors’ relevant financial disclosures.
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Ross EL, et al. JAMA Ophthalmol. 2016;doi:10.1001/jamaophthalmol.2016.1669.
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