Research, conducted by the Diabetic Retinopathy Clinical Research Network (DRCRN), suggests that aflibercept (2.0mg) and ranibizumab (0.3mg) are not cost effective when compared to bevacizumab for the treatment of diabetic macular edema (DME). The study, led by researchers at the Jaeb Center for Health Research, Tampa, Florida, and published in the US journal JAMA Ophthalmology, reported that the incremental cost-effectiveness ratios (ICER) for aflibercept (Eylea) and ranibizumab (Lucentis), compared with bevacizumab (Avastin), were $1.1M per quality-adjusted life-year (QALY) and $1.7M per QALY, respectively. Using acquisition prices for FY2015, the researchers calculated the costs of the anti-VEGF treatments at $1,850 per dose of aflibercept, $1,170 per dose of ranibizumab and $60 per dose of bevacizumab (re-packaged into synringes of 1.25mg active ingredient). The study concluded that, from a societal perspective, first line treatment of DME with bevacizumab would confer the greatest value in the context of scarce healthcare resources.
Recent medical studies by the same DRCRN network had found that treatment for DME with aflibercept produced greater mean VA gains at 1 year compared to bevacizumab or ranibizumab (at least for patients with Snellen equivalent baseline VA of 20/50 or worse). However, physicians, patients and healthcare managers are obliged to consider both medical and economic costs for treatments, especially when there is a considerable range in respect of treatments and costs, as presently exists for anti-VEGF medications. To determine the costs and benefits for such decision making the study included 624 participants with a mean age of 60.6 +/-10.5 years (45.7% female; 65.5% white), randomized to treatment with aflibercept, bevacizumab, or ranibizumab. The VA levels at each visit were converted to QALYs using a standard computation, while cost-effectiveness beyond 1 year was based on a mathematical model derived from a previous analysis.
The results of the study showed that total mean costs per participant over 1 year (including study eye and non-study eye anti-VEGF injections, laser photocoagulation, and adverse events) for treatment with aflibercept, bevacizumab, and ranibizumab groups, respectively, were $26,100 (95% CI, $24,400-27,700), $4,100 (95% CI, $3,000-5,200), and $18,600 (95% CI, $17,100-20,200). Analysis of the data, including 10-year forecasted projections, indicated that the VA benefits of aflibercept only translated into “modest quality-of-life improvements but at a high cost relative to bevacizumab, with the ICERs substantially higher than thresholds of $50,000 to $150,000 per QALY frequently cited in cost-effectiveness literature and US guidelines.” The study concluded from a health policy perspective that bevacizumab represented the best choice at the population level and that both aflibercept and ranibizumab would need to reduce substantially in cost in order to reach a cost-effectiveness threshold of $100,000 per QALY at 10 years.