Cost utility of ranibizumab versus aflibercept for treating Greek patients with visual impairment due to diabetic macular edema
BackgroundTo 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.MethodsA 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.ResultsThe use of PRN and T&E ranibizumab regimens were shown to be cost saving comparing to aflibercept (by EUR2824 and EUR22, 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 EUR3984 and EUR1278, respectively.ConclusionsBoth 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.
Cost Effectiveness and Resource Allocation