Cost-effectiveness of ranibizumab in treatment of diabetic macular oedema (DME) causing visual impairment: evidence from the RESTORE trial
- Paul Mitchell1,
- Lieven Annemans2,
- Meghan Gallagher3,
- Rafiq Hasan3,
- Simu Thomas4,
- Kerry Gairy5,
- Martin Knudsen6,
- Henrietta Onwordi6
- 1Centre for Vision Research, Westmead Millennium Institute, University of Sydney, Sydney, NSW, Australia
- 2Ghent University, Ghent, Belgium
- 3Novartis Pharma AG, Basel, Switzerland
- 4Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
- 5Novartis Pharmaceuticals, Frimley, UK
- 6IMS Health, London, UK
- Correspondence to Dr Professor Paul Mitchell, Centre for Vision Research, Westmead Millennium Institute, Westmead Hospital, Hawkesbury Rd, Westmead, 2145 Australia;
Contributors All authors contributed to the conception and design of the modelling, the analysis and interpretation of the clinical and economic data, participated in the development and writing of the manuscript, and approved the final draft for publication.
- Accepted 2 November 2011
- Published Online First 7 March 2012
Background/aims To evaluate the cost-effectiveness of ranibizumab as either monotherapy or combined with laser therapy, compared with laser monotherapy, in the treatment of diabetic macular oedema (DME) causing visual impairment from a UK healthcare payer perspective.
Methods A Markov model simulated long-term outcomes and costs of treating DME in one eye (BCVA ≤75 letters) based on data from the RESTORE Phase III trial. Outcomes measured in quality-adjusted life-years (QALYs) were simulated for a 15-year time horizon based on 12-month follow-up from RESTORE and published long-term data. Costs included treatment, disease monitoring, visual impairment and blindness (at 2010 price levels).
Results Ranibizumab monotherapy resulted in a 0.17 QALY gain at an incremental cost of £4191 relative to laser monotherapy, yielding an incremental cost-effectiveness ratio (ICER) of £24 028. Probabilistic sensitivity analysis showed a 64% probability of being cost-effective at a threshold of £30 000 per QALY. Combined ranibizumab and laser therapy resulted in a 0.13 QALY gain at an incremental cost of £4695 relative to laser monotherapy (ICER £36 106; 42% probability of ICER <£30 000).
Conclusions Based on RESTORE 1-year follow-up data, ranibizumab monotherapy appears to be cost-effective relative to laser monotherapy, the current standard of care. Cost-effectiveness of combination therapy is less certain. Ongoing studies will further inform on disease progression and the need for additional ranibizumab treatment.
- diabetic macular oedema
- visual impairment
- treatment medical
- clinical trial
- public health
Funding This study was supported by Novartis Pharma AG, Basel, Switzerland.
Competing interests PM has received a consultancy fee from Novartis Pharma AG, Pfizer, Solvay and Allergan. He has also been paid lecture fees/honoraria by Novartis Pharma AG, Pfizer, Solvay and Allergan. LA has received unrestricted grants from Novartis Pharma AG. SKT is an employee of Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA. KG is an employee of Novartis Pharmaceuticals, Frimley, UK. RH is an employee of Novartis Pharma AG, Basel, Switzerland and a Novartis shareholder. MK and HO were employed as consultants by Novartis Pharma AG for this study. MG was formerly employed by Novartis Pharma AG, Basel, Switzerland; current affiliation Amgen Inc., Thousand Oaks, CA, USA.
Provenance and peer review Not commissioned; externally peer reviewed.
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