PMID- 24777708 OWN - NLM STAT- MEDLINE DCOM- 20150511 LR - 20220408 IS - 1435-702X (Electronic) IS - 0721-832X (Linking) VI - 252 IP - 12 DP - 2014 Dec TI - The cost-utility of aflibercept for the treatment of age-related macular degeneration compared to bevacizumab and ranibizumab and the influence of model parameters. PG - 1911-20 LID - 10.1007/s00417-014-2641-3 [doi] AB - BACKGROUND: Age-related macular degeneration (AMD) is a blinding disease placing considerable burden on society due to blindness-associated costs. Intravitreal anti-vascular endothelial growth factors (anti-VEGFs) are effective in reducing the incidence of blindness, but at potentially high costs, depending on the cost of the drug used. Aflibercept has been introduced as an anti-VEGF equally effective to ranibizumab, but less costly. For this new drug, new cost-effectiveness analyses are needed, and AMD models used today give biased results. We investigated the cost-effectiveness of aflibercept compared to bevacizumab, ranibizumab, and no treatment and studied the influence of commonly used model parameters. METHODS: A patient-level, visual acuity-based, 2-eye model was developed. Data on effectiveness were derived from randomized controlled trials evaluating the outcomes of aflibercept, bevacizumab, and ranibizumab. Utility and resource utilization were assessed in interviews with AMD patients. Costs were based on standard health care cost prices. Time horizons were two and five years. A societal perspective was employed. RESULTS: Over five years, costs associated with aflibercept treatment were 36,030, with 2.15 QALYs. Costs associated with the bevacizumab regimens, ABC study as-needed (PRN); CATT study PRN; and CATT study 1x/month, were 19,367; 26,746; and 30,520, with 2.16; 2.17; and 2.15 QALYs, respectively. Costs associated with ranibizumab PRN and 1x/month were 45,491 and 74,837 with 2.16 and 2.15 QALYs, respectively. 'No treatment' was associated with 9530 and 1.96 QALYs. The incremental cost-effectiveness ratios versus 'no treatment' were: aflibercept-140,274; bevacizumab-51,062 (ABC PRN), 83,256 (CATT PRN) and 110,361 (1x/month); ranibizumab-181,667 (PRN) and 349,773 (1x/month). Results were highly dependent on whether only one or both eyes were included, length of time horizon, and whether the costs of blindness and low-vision were included in the analysis. CONCLUSIONS: Aflibercept is a cost-effective treatment for AMD over ranibizumab. However, aflibercept is not a cost-effective treatment when compared to bevacizumab. Application of inappropriate model assumptions leads to a biased cost-saving estimate of the cost-effectiveness of aflibercept. Therefore, cost-effectiveness analyses should be conducted with appropriate models. FAU - Elshout, Mari AU - Elshout M AD - University Eye Clinic Maastricht, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands, m.elshout@mumc.nl. FAU - van der Reis, Margriet I AU - van der Reis MI FAU - Webers, Carroll A B AU - Webers CA FAU - Schouten, Jan S A G AU - Schouten JS LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20140429 PL - Germany TA - Graefes Arch Clin Exp Ophthalmol JT - Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie JID - 8205248 RN - 0 (Angiogenesis Inhibitors) RN - 0 (Antibodies, Monoclonal, Humanized) RN - 0 (Recombinant Fusion Proteins) RN - 0 (VEGFA protein, human) RN - 0 (Vascular Endothelial Growth Factor A) RN - 15C2VL427D (aflibercept) RN - 2S9ZZM9Q9V (Bevacizumab) RN - EC 2.7.10.1 (Receptors, Vascular Endothelial Growth Factor) RN - ZL1R02VT79 (Ranibizumab) SB - IM MH - Aged MH - Aged, 80 and over MH - Angiogenesis Inhibitors/*economics/therapeutic use MH - Antibodies, Monoclonal, Humanized/*economics/therapeutic use MH - Bevacizumab MH - *Cost-Benefit Analysis MH - Drug Costs MH - Female MH - Health Care Costs MH - Humans MH - Intravitreal Injections MH - Macular Degeneration/drug therapy/*economics MH - Male MH - Middle Aged MH - Models, Economic MH - Monte Carlo Method MH - Quality-Adjusted Life Years MH - Ranibizumab MH - Receptors, Vascular Endothelial Growth Factor/*economics/therapeutic use MH - Recombinant Fusion Proteins/*economics/therapeutic use MH - Vascular Endothelial Growth Factor A/antagonists & inhibitors MH - Visual Acuity/physiology EDAT- 2014/04/30 06:00 MHDA- 2015/05/12 06:00 CRDT- 2014/04/30 06:00 PHST- 2013/10/13 00:00 [received] PHST- 2014/04/07 00:00 [accepted] PHST- 2014/02/16 00:00 [revised] PHST- 2014/04/30 06:00 [entrez] PHST- 2014/04/30 06:00 [pubmed] PHST- 2015/05/12 06:00 [medline] AID - 10.1007/s00417-014-2641-3 [doi] PST - ppublish SO - Graefes Arch Clin Exp Ophthalmol. 2014 Dec;252(12):1911-20. doi: 10.1007/s00417-014-2641-3. Epub 2014 Apr 29.