Cost-effectiveness of ranibizumab in treatment of diabetic macular oedema (DME) causing visual impairment: Evidence from the RESTORE trial

摘要

Background/aims: To evaluate the cost-effectiveness of ranibizumab as either monotherapy or combined with laser therapy, compared with laser monotherapy, in the treatment of diabetic macular oedema (DME) causing visual impairment from a UK healthcare payer perspective. Methods: A Markov model simulated long-term outcomes and costs of treating DME in one eye (BCVA ≤75 letters) based on data from the RESTORE Phase III trial. Outcomes measured in quality-adjusted life-years (QALYs) were simulated for a 15-year time horizon based on 12-month follow-up from RESTORE and published long-term data. Costs included treatment, disease monitoring, visual impairment and blindness (at 2010 price levels). Results: Ranibizumab monotherapy resulted in a 0.17 QALY gain at an incremental cost of ￡4191 relative to laser monotherapy, yielding an incremental costeffectiveness ratio (ICER) of ￡24 028. Probabilistic sensitivity analysis showed a 64% probability of being cost-effective at a threshold of ￡30 000 per QALY. Combined ranibizumab and laser therapy resulted in a 0.13 QALY gain at an incremental cost of ￡4695 relative to laser monotherapy (ICER ￡36 106; 42% probability of ICER <￡30 000). Conclusions: Based on RESTORE 1-year follow-up data, ranibizumab monotherapy appears to be cost-effective relative to laser monotherapy, the current standard of care. Cost-effectiveness of combination therapy is less certain. Ongoing studies will further inform on disease progression and the need for additional ranibizumab treatment.