Health Economic Evaluation Of A PRN Treatment Schedule With Ranibizumab (Lucentis®) In Wet AMD Based On New Clinical Evidence

1. Paul Mitchell¹
2. Karen Moeremans²
3. Laetitia Gerlier²
4. Meghan Gallagher³

¹University of Sydney, Sydney, Australia
²IMSHealth HEOR, Vilvoorde, Belgium
³Novartis Pharma AG, Basel, Switzerland

Purpose: To assess the cost-utility (cost per Quality Adjusted Life Year (QALY)) of a PRN dosing schedule with ranibizumab (RBZ-PRN) in wet subfoveal age-related macular degeneration (AMD) from a UK health care payer perspective.

Methods: A Markov model was developed, that predicts 10-year visual acuity in wet AMD with different RBZ dosing schedules and with comparator treatments best supportive care (BSC) and Visudyne® photodynamic therapy (PDT). Visual acuity, injection frequency and safety were obtained from clinical trials. Data sources for the analysis included pooled SUSTAIN and MONT-BLANC trial data for RBZ-PRN; ANCHOR, MARINA, TAP, PIER and EXCITE trial data were used for modeling RBZ-monthly (RBZ-M), RBZ-quarterly (RBZ-Q), BSC and PDT. Two-year treatment was followed by BSC. Costs were obtained from literature and expert opinion, updated to 2009. Utilities were obtained using time-trade-off methodology. Costs and effects were discounted (3.5%).

Results: Compared to BSC and PDT, RBZ-PRN was associated with the most favorable cost-utility ratio among the RBZ dosing schedules. The cost-utility of RBZ-PRN versus BSC and PDT remained below 30,000£/QALY regardless of selected source for comparator data. RBZ-PRN was dominant (more effective and less costly) versus RBZ-Q. RBZ-M was slightly more effective but not cost-effective versus RBZ-PRN. The result was most sensitive to time horizon (2-10y), cost of blindness and treatment duration (1-3y) but conclusions remained throughout the sensitivity analyses.

Conclusions: Using the SUSTAIN and MONT-BLANC re-treatment criteria, RBZ-PRN is cost-effective compared to other therapies for wet-AMD and represents the most cost-effective use of RBZ.