TY - JOUR
T1 - Cost-Utility of Anti–Vascular Endothelial Growth Factor Treatment for Macular Edema Secondary to Central Retinal Vein Occlusion
AU - Lin, James
AU - Gibbons, Allister
AU - Smiddy, William E.
N1 - Funding Information:
Supported by the National Institutes of Health , Bethesda, Maryland (center core grant no.: P30EY014801 to the Bascom Palmer Eye Institute); Research to Prevent Blindness , Inc., New York, New York (unrestricted grant); and the United States Department of Defense , Washington, DC (grant no.: W81XWH-09-1-0675 ); Lewis Henkind and the Irving and Branna Sisenwein Endowment Fund (to the Department of Ophthalmology, Montefiore Medical Center, Bronx, NY).
Publisher Copyright:
© 2020 American Academy of Ophthalmology
PY - 2021/7
Y1 - 2021/7
N2 - Purpose: To evaluate the cost-utility of treatment for macular edema in central retinal vein occlusion (CRVO) using intravitreal injections of the anti–vascular endothelial growth factor (VEGF) agents bevacizumab, ranibizumab, and aflibercept. Design: Decision analysis model of cost-utility. Participants: Data from study participants in the Lucentis, Eylea, Avastin in Vein Occlusion (LEAVO) study. Methods: A decision analysis of a disease simulation model was used to calculate comparative cost-utility of intravitreal bevacizumab (IVB), intravitreal ranibizumab (IVR), and intravitreal aflibercept (IVA) for the treatment of macular edema associated with CRVO based on data from the LEAVO study. Center for Medicare and Medicaid Services data were used to calculate associated modeled costs in a hospital- or facility-based and nonfacility setting from a third-party payer perspective, and societal costs also were calculated. Cost utility was calculated based on the preserved visual utility during the 2 years of the study and also by estimating utility for the expected lifetime. Main Outcome Measures: Cost of treatment, cost per quality-adjusted life-year (QALY), and incremental cost-effectiveness ratio (ICER). Results: From the third-party payer perspective, the estimated lifetime costs per QALY in the facility and nonfacility settings were $39 325 and $17 944, respectively, for IVB; $114 095 and $92 653, respectively, for IVR; and $78 935 and $63 270, respectively, for IVA. From the societal perspective, the estimated lifetime costs per QALY in the facility setting were $52 754 for IVB, $128 242 for IVR, and $86 262 for IVA. The ICER of IVA compared with that of IVB was $153 633/QALY from the third-party facility setting and $152 992/QALY from the societal perspective. The use of IVB compared with IVR and IVA compared with IVR were cost-saving interventions (ICER, <0) regardless of the perspective or setting. Conclusions: In the treatment of macular edema in CRVO, IVB yields the best cost utility among the 3 anti-VEGF agents modeled. Intravitreal aflibercept maintains acceptable lifetime cost per QALY while having a favorable cost utility compared with IVR.
AB - Purpose: To evaluate the cost-utility of treatment for macular edema in central retinal vein occlusion (CRVO) using intravitreal injections of the anti–vascular endothelial growth factor (VEGF) agents bevacizumab, ranibizumab, and aflibercept. Design: Decision analysis model of cost-utility. Participants: Data from study participants in the Lucentis, Eylea, Avastin in Vein Occlusion (LEAVO) study. Methods: A decision analysis of a disease simulation model was used to calculate comparative cost-utility of intravitreal bevacizumab (IVB), intravitreal ranibizumab (IVR), and intravitreal aflibercept (IVA) for the treatment of macular edema associated with CRVO based on data from the LEAVO study. Center for Medicare and Medicaid Services data were used to calculate associated modeled costs in a hospital- or facility-based and nonfacility setting from a third-party payer perspective, and societal costs also were calculated. Cost utility was calculated based on the preserved visual utility during the 2 years of the study and also by estimating utility for the expected lifetime. Main Outcome Measures: Cost of treatment, cost per quality-adjusted life-year (QALY), and incremental cost-effectiveness ratio (ICER). Results: From the third-party payer perspective, the estimated lifetime costs per QALY in the facility and nonfacility settings were $39 325 and $17 944, respectively, for IVB; $114 095 and $92 653, respectively, for IVR; and $78 935 and $63 270, respectively, for IVA. From the societal perspective, the estimated lifetime costs per QALY in the facility setting were $52 754 for IVB, $128 242 for IVR, and $86 262 for IVA. The ICER of IVA compared with that of IVB was $153 633/QALY from the third-party facility setting and $152 992/QALY from the societal perspective. The use of IVB compared with IVR and IVA compared with IVR were cost-saving interventions (ICER, <0) regardless of the perspective or setting. Conclusions: In the treatment of macular edema in CRVO, IVB yields the best cost utility among the 3 anti-VEGF agents modeled. Intravitreal aflibercept maintains acceptable lifetime cost per QALY while having a favorable cost utility compared with IVR.
KW - Aflibercept
KW - Bevacizumab
KW - Central retinal vein occlusion
KW - Cost utility
KW - Intravitreal ranibizumab
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U2 - 10.1016/j.oret.2020.09.017
DO - 10.1016/j.oret.2020.09.017
M3 - Article
C2 - 33002672
AN - SCOPUS:85096881238
SN - 2468-7219
VL - 5
SP - 656
EP - 663
JO - Ophthalmology Retina
JF - Ophthalmology Retina
IS - 7
ER -
