The purpose of this study was to investigate the cost effectiveness of ranibizumab compared with verteporfin photodynamic therapy, pegaptanib sodium, and best supportive care for the treatment of AMD in Greece.
A 6-state Markov model was constructed according to patient visual acuity in the better-seeing eye. Data on effectiveness were derived from randomized controlled trials evaluating the outcomes of ranibizumab versus alternative AMD treatments. Resource utilization reflected the Greek health care setting and was defined by a panel of experts. All treatments were administered for a 2-year period and evaluated during a 10-year time frame from a third-party payer perspective and discounted at 3.5 % per annum.
Estimated mean 10-year direct costs of treatment in the ranibizumab arm ranged from ?3,733 to ?1,795 (2011 Euros), with a projected gain of 4.50 to 4.74 quality-adjusted life years (QALYs) or 2.97 to 4.47 vision years, depending on type of lesion. For predominantly classic lesions, the cost per QALY gained with ranibizumab was estimated at ?444/QALY (95 % uncertainty interval [UI], ?30,403/QALY to ?4,524/QALY), ?5,344 (95 % UI, ?11,433 to ?3,554) and dominant relative to photodynamic therapy, best supportive care, and pegaptanib, respectively. Corresponding ratios for patients with minimally classic lesions were ?4,580/QALY (95 % UI, ?5580/QALY to ?6,229/QALY) and ?3,112/QALY (95 % UI, ?3839/QALY to ?7,527/QALY) for ranibizumab relative to best supportive care and pegaptanib, and for patients with occult lesions were estimated at ?9,407/QALY (95 % UI, ?1486 to ?6,434) and ?8,561/QALY (95 % UI, ?143 to 73,431), respectively. Sensitivity analysis provided robust results in all cases.
Ranibizumab can be a cost-effective option for the treatment of AMD compared with selected alternatives in the Greek health care setting.