PharmacoEconomics & Outcomes News 555 - 14 Jun 2008

AMD news from ISPORToronto, Ontario, Canada May 2008

As age-related macular degeneration (AMD) becomes ranibizumab with an 89.8% probability.more prevalent due to a longer life expectancy and a rise It pays to stave off blindnessin the number of elderly people worldwide, it will be Despite its high treatment costs, ranibizumab is "aincreasingly important to understand the potential dominant strategy" compared to PDT and BSC, "primarilyhealth and economic impact of the disorder for because it prevents patients from reaching the highlyappropriate healthcare planning. Several new agents are expensive state of blindness", say US-basednow available to treat AMD, and the cost effectiveness of investigators. 4 Indeed, treating AMD patients withsome of these strategies was examined in studies ranibizumab "before they reach a legal blindness statepresented at the 13th Annual International Meeting of can generate considerable cost-savings to society", theythe Society for Pharmacoeconomics and Outcomes assert.Research (ISPOR). The researchers used data obtained from theRanibizumab on the money in Canada . . . ANCHOR and MARINA clinical trials to construct a cost-

Ranibizumab offers "good value for money" versus effectiveness model with a 10-year time horizon. Thecurrent standard treatments for all wet AMD lesions model compared costs and outcomes for ranibizumabtypes, researchers from Canada declare.1 0.5mg and 0.3mg versus PDT and BSC among patients

A 10-year Markov model was used to assess the cost with AMD. For patients with predominantly classiceffectiveness of ranibizumab 0.5mg at a dose of nine AMD, ranibizumab 0.5mg would be a dominant strategyinjections in year 1 and six injections in year 2, relative to PDT/ SC, while it would cost $US62 905/compared with photodynamic therapy with verteporfin QALY, compared with ranibizumab 0.3mg. For patients(PDT-V) and best standard care (BSC) among patients with minimally classic or occult AMD, ranibizumabwith subfoveal wet AMD. According to the model, and 0.5mg would be the dominant strategy versus PDT/assuming a $Can50 000/QALY* threshold, ranibizumab BSC; ranibizumab 0.5mg would cost $US322 367/QALYdemonstrated cost effectiveness relative to PDT-V and gained relative to ranibizumab 0.3mg.BSC in all lesion types. Influential variables included a patient’s baseline

For predominantly classic lesions, the incremental visual acuity, costs associated with visual impairment,cost-effectiveness ratios (ICERs) for ranibizumab versus and the acquisition cost of ranibizumab.PDT-V and BSC would be $Can4167/QALY and Ranibizumab still looks likely vs pegaptanib$Can21 857/QALY, respectively. For minimally classic Both ranibizumab and pegaptanib were found beand occult lesions, the ICERs would be $Can37 363/ costly for AMD treatment in a US-based cost-QALY and $Can38 151/QALY, respectively, for effectiveness model; however, a lower ICER forranibizumab versus PDT/BSC. ranibizumab suggests that this drug may be the first. . . and dominant in Brazil consideration for anti-VEGF therapy.5

A modelling analysis conducted in Brazil has Basic decision analysis compared ranibizumab,confirmed that ranibizumab is "the dominant therapy" pegaptanib and placebo for AMD patients, with baselinefor the treatment of wet AMD.2 cost estimates of $US31 564, $US13 066 and $US3152

The researchers used a 5-year decision-analysis per patient, respectively. Compared with placebo,model with a Markov chain to assess the costs and ranibizumab would cost an extra $US80 121 per unitoutcomes associated with ranibizumab and pegaptanib increase in effectiveness, while the figure for pegaptanibin wet AMD, from a private payer’s perspective. versus placebo would be $US934 433 per additional

The model showed that ranibizumab would be unit of effectiveness.associated with greater benefits than pegaptanib, in The researchers note that, although ranibizumabterms of vision-years gained (2.66 vs 2.00), and would has a "much higher" acquisition cost thanalso incur the lowest total per-patient cost ($US29 653 pegaptanib, it has a higher probability of successvs $US30 093). Incremental analysis showed (0.95 for ranibizumab vs 0.7 for pegaptanib). Futureranibizumab to be the dominant alternative, with studies should endeavour to investigate more quality ofgreater net benefits than pegaptanib, independent of life factors, the researchers conclude.willingness to pay (WTP). Sensitivity analysis revealed * Costs were calculated in 2007 Canadian dollars from the Ontariothe model’s results to be sensitive to the type of lesion Ministry of Health perspective; costs and outcomes were discounted

at an annual rate of 5%.treated.1. Lozano-Ortega G, et al. The cost-effectiveness of ranibizumab compared toBevacizumab eyes the prize in the US

PDT-V and BSC for the treatment of age-related macular degeneration inBevacizumab was found to be more cost effective Canada. Value in Health 11: A286, No. 3, May-Jun 2008.

2. Bueno RLP, et al. Cost-effectiveness of anti VEGF therapies for wet age-relatedthan ranibizumab for wet AMD in a US analysis, due tomacular degeneration in Brazil: the private payer perspective. Value in Healthlower acquisition costs.311: A287, No. 3, May-Jun 2008.

In a Markov model simulated over 20 years from a 3. Patel JJ, et al. Cost-effectiveness analysis of bevacizumab and ranibizumab inneovascular age-related macular degeneration: a clinical and economicpayer’s perspective, bevacizumab was shown to costcomparison of two vascular endothelial growth factor inhibitor treatments. Value$US2454 per QALY gained, compared with $US12 327 in Health 11: A288, No. 3, May-Jun 2008.

4. Turpcu A, et al. The cost-effectiveness of ranibizumab (Lucentis Rm) in treatingper QALY gained for ranibizumab.patients with predominantly classic, minimally classic, and occult neovascularThe ICER for ranibizumab versus bevacizumabage-related macular degeneration. Value in Health 11: A288-A289, No. 3, May-

would be $US258 355 per QALY gained – not cost Jun 2008.5. Lu LY, et al. Cost-effective analysis of pegaptanib (Macugen Rm) as comparedeffective based on a WTP of $US50 000/QALY.

with ranibizumab (Lucentis Rm) for treating in age-related macularProbabilistic sensitivity analysis showed that degeneration. Value in Health 11: A288, No. 3, May-Jun 2008.bevacizumab would be more cost effective than 801085103

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PharmacoEconomics & Outcomes News 14 Jun 2008 No. 5551173-5503/10/0555-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved