Cost-Effectiveness of Ranibizumab and PRP for Proliferative DR
JAMA Ophthalmology, December 2019
In a secondary analysis from the DRCR.net Protocol S study, Hutton et al. compared the cost-effectiveness of ranibizumab and panretinal photocoagulation (PRP) for patients who had proliferative diabetic retinopathy (PDR) but did not have center-involved diabetic macular edema (DME) and associated loss of visual acuity. They found that the first-line use of PRP is a more cost-effective approach for these patients.
Five-year efficacy, safety, and resource utilization data were gathered for 213 adults with PDR, and results were simulated through 10 years. Treatment protocols were intravenous ranibizumab (0.5 mg) at baseline and up to every four weeks thereafter (per a structured retreatment protocol) versus PRP at baseline. Any eye, regardless of treatment assignment, could receive ranibizumab for concomitant DME involving vision loss. Main outcomes were incremental cost-effectiveness ratios (ICERs) for each treatment among patients (including those who did have center-involved DME at baseline).
At year 5, mean costs for patients with vision-impairing DME at baseline were $22,355 for the PRP group and $40,825 for the ranibizumab group. Quality-adjusted life-years (QALYs) were 0.02 and 0.30, respectively. For patients without center-involved DME at baseline, the ICER of ranibizumab relative to PRP was $582,268/QALY at five years and $742,202/QALY at 10 years. For patients with center-involved DME at baseline, the ICERs for ranibizumab were $65,576/QALY at five years and $63,930/QALY at 10 years.
Based on these analyses, ranibizumab is likely to be cost-effective for patients with PDR and center-involved DME but unlikely to be more cost-effective than PRP for those without center-involved DME. These findings are consistent with the earlier two-year results of Protocol S.
Although a lower dose of ranibizumab (0.3 mg) is available and may help to reduce costs, the present study involved only the 0.5-mg dose. The authors acknowledged that it would be difficult to generalize the cost-effectiveness of ranibizumab to that of other anti-VEGF agents because long-term data for other drugs are lacking. A lower price point for a drug that is at least as effective as ranibizumab may render anti-VEGF therapy cost-effective for PDR treatment even if center-involved DME is absent. The authors noted that their findings may be considered with patient-specific factors when choosing a treatment for PDR. (Also see related commentary by Steven M. Kymes, PhD, and David Vollman, MD, in the same issue.)
The original article can be found here.