Valutazione di costo-efficacia di bevacizumab vs ranibizumab nel trattamento della degenerazione maculare senile essudativa

DOI 10.23753/htafocus2016.02.007

Annalisa Ferrero, Michele Amadio, Savino D’Amelio, Graziella Sassi


Objective: Anti-vascular endothelial growth factor (VEGF) therapies have revolutionized the treatment of exudative age-related macular degeneration (AMD); yet these agents are expensive, and whether they are cost-effective is unclear. The purpose of this study was to determine the most cost-effective treatment option for patients with newly diagnosed AMD: intravitreal ranibizumab or bevacizumab, which costs up to 50 times less.
Methods: Two Markov models were applied in cost-utility analysis to evaluate the incremental cost-effectiveness ratio (ICER) between ranibizumab and bevacizumab from SSN perspective over 10 years. The first one considered three health states, whereas in the second one a fourth health state, concerning side effects, was included. Transitional probabilities were obtained and extrapolated from medical records of patients under anti-VEGF treatment at Ophtalmic Hospital
“C. Sperino” (ASL TO1). Direct medical costs, utility scores side effects probability and costs associated with side effects management were obtained from published studies.
Results: In the first model, cost-effectiveness ratio (CER) for ranibizumab and bevacizumab were € 2153.48 and € 40.16 per QALY, respectively: the ICER for bevacizumab was dominant compared to ranibizumab. When side effects were included, by using  the second model, CER for ranibizumab was € 2204.82 per QALY and € 70.45 per QALY for bevacizumab: bevacizumab remained the cost-effective treatment.
Conclusions: Even after considering the potential for differences in risks of serious adverse events and therapeutic effectiveness, bevacizumab confers considerably greater value than ranibizumab for the treatment of exudative macular degeneration.

Key words: ranibizumab, bevacizumab, exudative age-related macular degeneration, cost-effectiveness, cost-utility