Cost Effectiveness of Ranibizumab vs Aflibercept vs Bevacizumab for the Treatment of Macular Oedema Due to Central Retinal Vein Occlusion: The LEAVO Study

Becky Pennington*, Abualbishr Alshreef, Laura Flight, Andrew Metry, Edith Poku, Philip Hykin, Sobha Sivaprasad, A. Toby Prevost, Joana C. Vasconcelos, Caroline Murphy, Joanna Kelly, Yit Yang, Andrew Lotery, Michael Williams, John Brazier

*Corresponding author for this work

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Abstract

Background: 

We aimed to assess the cost effectiveness of intravitreal ranibizumab (Lucentis), aflibercept (Eylea) and bevacizumab (Avastin) for the treatment of macular oedema due to central retinal vein occlusion. 

Methods: 

We calculated costs and quality-adjusted life-years from the UK National Health Service and Personal Social Services perspective. We performed a within-trial analysis using the efficacy, safety, resource use and health utility data from a randomised controlled trial (LEAVO) over 100 weeks. We built a discrete event simulation to model long-term outcomes. We estimated utilities using the Visual-Functioning Questionnaire-Utility Index, EQ-5D and EQ-5D with an additional vision question. We used standard UK costs sources for 2018/19 and a cost of £28 per bevacizumab injection. We discounted costs and quality-adjusted life-years at 3.5% annually. 

Results: 

Bevacizumab was the least costly intervention followed by ranibizumab and aflibercept in both the within-trial analysis (bevacizumab: £6292, ranibizumab: £13,014, aflibercept: £14,328) and long-term model (bevacizumab: £18,353, ranibizumab: £30,226, aflibercept: £35,026). Although LEAVO did not demonstrate bevacizumab to be non-inferior for the visual acuity primary outcome, the three interventions generated similar quality-adjusted life-years in both analyses. Bevacizumab was always the most cost-effective intervention at a threshold of £30,000 per quality-adjusted life-year, even using the list price of £243 per injection. 

Conclusions: 

Wider adoption of bevacizumab for the treatment of macular oedema due to central retinal vein occlusion could result in substantial savings to healthcare systems and deliver similar health-related quality of life. However, patients, funders and ophthalmologists should be fully aware that LEAVO could not demonstrate that bevacizumab is non-inferior to the licensed agents.

Original languageEnglish
JournalPharmacoEconomics
Early online date26 Apr 2021
DOIs
Publication statusEarly online date - 26 Apr 2021

Bibliographical note

Funding Information:
The authors thank all the patients who participated in LEAVO study, Jayashree Ramu (Moorfield Biomedical Research Centre, London, UK) and the LEAVO study group for help in collecting data alongside the LEAVO clinical trial for this economic evaluation. We thank Jon Tosh, Hasan Basarir and Melinda Goodall for their contributions to the conception and design of this analysis. This report presents independent research funded by the UK National Institute for Health Research (NIHR) Health Technology Assessment Programme and supported by the NIHR Biomedical Research Centre at Moorfields Eye Hospital. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.

Funding Information:
This project was funded by the NIHR Health Technology Assessment Programme (11/92/03) and supported by the NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust. The NIHR had no role in the design or conduct of this research.

Funding Information:
Sobha Sivaprasad reports grants and personal fees from Bayer, grants and personal fees from Novartis, grants and personal fees from Boehringer Ingleheim, grants and personal fees from Roche, and personal fees and non-financial support from Optos, outside the submitted work. Andrew Lotery reports personal fees from Novartis and non-financial support from Bayer, outside the submitted work. Michael Williams reports speaker fees and travel grants from Allergan, Bayer and Novartis. Andrew Metry reports grants from the NIHR Health Technology Assessment Grants Programme during the conduct of the study. Philip Hykin reports grants from NIHR Health Technology Assessment Programme (11/92/03) during the conduct of the study; grants, personal fees and non-financial support from BAYER, grants, personal fees and non-financial support from NOVARTIS, and grants, personal fees and non-financial support from Allergan, outside the submitted work. A. Toby Prevost reports personal fees from Bayer and grants from Boehinger-Ingleheim, outside the submitted work. Yit Yang reports personal fees and non-financial support from Novartis, personal fees and non-financial support from Bayer, personal fees and non-financial support from Allergan and personal fees and non-financial support from Roche, outside the submitted work. Becky Pennington, Abualbishr Alshreef, Laura Flight, Edith Poku, Joana C. Vasconcelos, Caroline Murphy, Joanna Kelly and John Brazier have no conflicts of interest that are directly relevant to the content of this article.

Publisher Copyright:
© 2021, The Author(s).

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

ASJC Scopus subject areas

  • Pharmacology
  • Health Policy
  • Public Health, Environmental and Occupational Health

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