Cost Effectiveness of Ranibizumab vs Aflibercept vs Bevacizumab for the Treatment of Macular Oedema Due to Central Retinal Vein Occlusion: The LEAVO Study

Becky Pennington (), Abualbishr Alshreef, Laura Flight, Andrew Metry, Edith Poku, Philip Hykin, Sobha Sivaprasad, A. Toby Prevost, Joana C. Vasconcelos, Caroline Murphy, Joanna Kelly, Yit Yang, Andrew Lotery, Michael Williams and John Brazier
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Becky Pennington: University of Sheffield
Abualbishr Alshreef: University of Sheffield
Laura Flight: University of Sheffield
Andrew Metry: University of Sheffield
Edith Poku: University of Sheffield
Philip Hykin: NIHR Moorfields Biomedical Research Centre
Sobha Sivaprasad: NIHR Moorfields Biomedical Research Centre
A. Toby Prevost: King’s College London
Joana C. Vasconcelos: King’s College London
Caroline Murphy: King’s College London
Joanna Kelly: King’s College London
Yit Yang: Wolverhampton Eye Infirmary
Andrew Lotery: University of Southampton
Michael Williams: Queen’s University of Belfast
John Brazier: University of Sheffield

PharmacoEconomics, 2021, vol. 39, issue 8, No 5, 913-927

Abstract: Abstract Background We aimed to assess the cost effectiveness of intravitreal ranibizumab (Lucentis), aflibercept (Eylea) and bevacizumab (Avastin) for the treatment of macular oedema due to central retinal vein occlusion. Methods We calculated costs and quality-adjusted life-years from the UK National Health Service and Personal Social Services perspective. We performed a within-trial analysis using the efficacy, safety, resource use and health utility data from a randomised controlled trial (LEAVO) over 100 weeks. We built a discrete event simulation to model long-term outcomes. We estimated utilities using the Visual-Functioning Questionnaire-Utility Index, EQ-5D and EQ-5D with an additional vision question. We used standard UK costs sources for 2018/19 and a cost of £28 per bevacizumab injection. We discounted costs and quality-adjusted life-years at 3.5% annually. Results Bevacizumab was the least costly intervention followed by ranibizumab and aflibercept in both the within-trial analysis (bevacizumab: £6292, ranibizumab: £13,014, aflibercept: £14,328) and long-term model (bevacizumab: £18,353, ranibizumab: £30,226, aflibercept: £35,026). Although LEAVO did not demonstrate bevacizumab to be non-inferior for the visual acuity primary outcome, the three interventions generated similar quality-adjusted life-years in both analyses. Bevacizumab was always the most cost-effective intervention at a threshold of £30,000 per quality-adjusted life-year, even using the list price of £243 per injection. Conclusions Wider adoption of bevacizumab for the treatment of macular oedema due to central retinal vein occlusion could result in substantial savings to healthcare systems and deliver similar health-related quality of life. However, patients, funders and ophthalmologists should be fully aware that LEAVO could not demonstrate that bevacizumab is non-inferior to the licensed agents.

Date: 2021
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DOI: 10.1007/s40273-021-01026-5

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