PharmacoEconomics & Outcomes News 804, p6 - 2 Jun 2018
Bevacizumab most cost-effective
treatment for AMD
Although bevacizumab (Avastin) is not yet registered
for age-related macular degeneration (AMD) in Europe,
it appears to be most cost-effective treatment for the
disease in Europe, according to findings of a study
published in PLOS One.
A decision-analytical model populated with data from
a systematic review and meta-analysis was used to
compare the cost effectiveness of bevacizumab as
needed, ranibizumab (Lucentis) as-needed, and
bimonthly aflibercept (Eylea) in patients with AMD,
from a societal perspective in Europe over a one-year
Treatment with bevacizumab was estimated to cost
per year, and aflibercept and ranibizumab
were estimated to cost approximately €4000 and
€6000 more, respectively. All three drugs were similarly
effective. Bevacizumab was therefore the most cost-
effective therapy at a willingness-to-pay (WTP)
threshold of €80 000 per QALY gained. It dominated
ranibizumab (more or equally effective and less costly).
The estimated incremental cost-effectiveness ratio for
aflibercept versus bevacizumab was €278 099 per
QALY gained. Aflibercept cost €943 per injection but the
estimated maximum price at which aflibercept would be
cost effective was €533 per injection at a WTP threshold
of €80 000 per QALY gained, and £347 per injection at
WTP threshold of £30 000 per QALY gained.
The cost-effectiveness acceptibility curve showed that
bevacizumab was likely to be the most cost effective
treatment up to a WTP threshold of €407 250 per QALY
gained. It was estimated that by using bevacizumab
instead of aflibercept for AMD, Europe would save
€335 million per yearly.
"The registered drugs ranibizumab and aflibercept
lead to large overspending without additional health
benefits. Health authorities should consider taking steps
to implement bevacizumab into clinical practice as first
choice," concluded the authors.
* 2014 euros
** National Institute for Health and Care Excellence (UK WTP
threshold valued British pounds)
van Asten F, et al. The cost-effectiveness of bevacizumab, ranibizumab and
aflibercept for the treatment of age-related macular degeneration - A cost-
effectiveness analysis from a societal perspective. PLOS One : 17 May 2018.
Available from: URL: https://doi.org/10.1371/journal.pone.0197670
PharmacoEconomics & Outcomes News 2 Jun 2018 No. 8041173-5503/18/0804-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved