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.

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