Cost-Utility of Anti-VEGF Treatment for Macular Edema Secondary to Central Retinal Vein Occlusion

Objective: To evaluate the cost-utility of treatment for macular edema in central retinal vein occlusion (CRVO) using intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents bevacizumab, ranibizumab, and aflibercept.

Design: A decision analysis model of cost-utility PARTICIPANTS: Data from study participants in the Lucentis, Eylea, Avastin in Vein Occlusion (LEAVO) study.

Methods: A decision analysis of a disease simulation model was used to calculate comparative cost-utility of intravitreal bevacizumab (IVB), ranibizumab (IVR), and aflibercept (IVA) for the treatment of macular edema associated with CRVO based on data from LEAVO study. Center for Medicare and Medicaid Services data were used to calculate associated modeled costs in a hospital/facility based and non-facility setting from a third-party payer perspective, and societal costs were also calculated. Cost-utility was calculated based on the preserved visual utility during the 2 years of the study and also by estimating utility for the expected lifetime.

Main outcome measures: Cost of treatment, cost/QALY, incremental cost-effectiveness ratio (ICER) RESULTS: From the third-party payer perspective, the estimated life-time cost/QALY in the facility (non-facility) setting was $39,325 ($17,944) for IVB, $114,095 ($92,653) for IVR, and $78,935 ($63,270) for IVA. From the societal perspective the estimated life-time cost/QALY in the facility setting was $52,754 for IVB, $128,242 for IVR, and $86,262 for IVA. The incremental cost-effectiveness ratio (ICER) of IVA compared to IVB was $153,633/QALY from the third-party facility setting and ($152,992/QALY) from the societal perspective. The use of IVB compared to IVR and IVA compared to IVR were cost-saving interventions (ICER<0) irrespective of the perspective or setting.

Conclusions: In the treatment of macular edema in CRVO, IVB yields the best cost-utility among the three anti-VEGF agents modeled. IVA maintains acceptable lifetime cost/QALY, while having a favorable cost-utility compared to IVR.

Keywords: Cost-utility; aflibercept; bevacizumab; central retinal vein occlusion; intravitreal ranibizumab.