Br J Ophthalmol 91:1244-1246 doi:10.1136/bjo.2007.116616
  • Perspective

Ranibizumab (Lucentis) versus bevacizumab (Avastin): modelling cost effectiveness

  1. James Raftery1,
  2. Andrew Clegg1,
  3. Jeremy Jones1,
  4. Seng Chuen Tan1,
  5. Andrew Lotery2
  1. 1
    Wessex Institute for Health R&D, Medical School, University of Southampton, Southampton, UK
  2. 2
    University of Southampton, Southampton Eye Unit, Southampton General Hospital, Southampton, UK
  1. James Raftery, Wessex Institute for Health R&D, Mailpoint 728, Medical School, University of Southampton, Southampton SO16 7PX, UK; raftery{at}soton,
  • Accepted 14 March 2007
  • Published Online First 12 April 2007


Two new drugs provide startling benefits in the treatment of age-related macular degeneration (AMD). The clinical and cost effectiveness of ranibizumab (Lucentis) was compared to that of bevacizumab (Avastin), which costs up to 100 times less. A cost effectiveness model was developed to assess the cost per quality adjusted life year (QALY) over 10 years. For predominantly classic AMD, the efficacy of bevacizumab relative to ranibizumab would have to be around 40% for the latter to achieve £30k per QALY, a NICE threshold. Similar but worse results applied to the other main forms of AMD, minimally occult and occult with no classic lesions. The price of ranibizumab would have to be drastically reduced for it to be cost effective. Continued unlicensed use of bevacizumab raises ethical, legal and policy questions. Public pressure may be the most potent weapon in persuading Genentech to license bevacizumab for AMD.


  • Competing interests: None declared.

  • Abbreviations:

    age-related macular degeneration


    minimally classic




    predominantly classic


    quality adjusted life year

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