MARKOV MODEL-BASED COST-UTILITY ANALYSIS COMPARING RANIBIZUMAB WITH PANRETINAL PHOTOCOAGULATION FOR PROLIFERATIVE DIABETIC RETINOPATHY IN INDIA
Author(s)
Shruthi Ashok Kumar, PharmD1, Norah E. Shynu, Pharm D2, Adusumilli Pramod Kumar, PhD3, JEESA GEORGE, M pharm3;
1M S Ramaiah University Of Applied Sciences, Bengaluru, India, 2M S Ramaiah University Of Applied Sciences, Pharmacy Practice, Bengaluru, India, 3M S Ramaiah University Of Applied Sciences, Bangalore, India
1M S Ramaiah University Of Applied Sciences, Bengaluru, India, 2M S Ramaiah University Of Applied Sciences, Pharmacy Practice, Bengaluru, India, 3M S Ramaiah University Of Applied Sciences, Bangalore, India
OBJECTIVES: Proliferative diabetic retinopathy (PDR) is a serious complication of diabetes, affecting nearly one in six people with the condition in India. Panretinal photocoagulation (PRP) has long been the standard treatment, while intravitreal ranibizumab offers better visual outcomes but comes at a much higher cost. This study set out to evaluate the cost-utility of ranibizumab compared with PRP from the perspective of the Indian healthcare payer.
METHODS: We developed a cohort‑based Markov model with 3‑month cycles and a 10‑year horizon to capture disease progression across eight best‑corrected visual activity states plus death. Transition probabilities, utilities, and costs were drawn from published trials, economic evaluations, and routine ophthalmology practice in India. Outcomes were measured in QALYs, with both costs and health benefits discounted at 3% annually. Incremental cost‑effectiveness ratios (ICERs) were calculated, and uncertainty was explored through probabilistic sensitivity analysis and results were plotted graphically.
RESULTS: Over 10 years, ranibizumab generated higher costs but only modestly greater QALYs compared with PRP. Mean total costs were ₹66,726.45 for PRP and ₹3,89,368.78 for ranibizumab, while QALYs gained were 16.7812 and 17.0294, respectively. The ICER for ranibizumab versus PRP was ₹13,00,256.33 per QALY gained, well above commonly referenced cost‑effectiveness thresholds for India. Probabilistic sensitivity analysis supported the base‑case findings, showing PRP remained consistently the preferred treatment option across a wide range of willingness‑to‑pay threshold values.
CONCLUSIONS: Ranibizumab provides some additional health benefits over PRP for Indian patients with PDR, but at current prices it is not cost‑effective. Substantial reductions in drug cost or alternative reimbursement approaches would be needed for ranibizumab to represent value for money in the Indian setting.
METHODS: We developed a cohort‑based Markov model with 3‑month cycles and a 10‑year horizon to capture disease progression across eight best‑corrected visual activity states plus death. Transition probabilities, utilities, and costs were drawn from published trials, economic evaluations, and routine ophthalmology practice in India. Outcomes were measured in QALYs, with both costs and health benefits discounted at 3% annually. Incremental cost‑effectiveness ratios (ICERs) were calculated, and uncertainty was explored through probabilistic sensitivity analysis and results were plotted graphically.
RESULTS: Over 10 years, ranibizumab generated higher costs but only modestly greater QALYs compared with PRP. Mean total costs were ₹66,726.45 for PRP and ₹3,89,368.78 for ranibizumab, while QALYs gained were 16.7812 and 17.0294, respectively. The ICER for ranibizumab versus PRP was ₹13,00,256.33 per QALY gained, well above commonly referenced cost‑effectiveness thresholds for India. Probabilistic sensitivity analysis supported the base‑case findings, showing PRP remained consistently the preferred treatment option across a wide range of willingness‑to‑pay threshold values.
CONCLUSIONS: Ranibizumab provides some additional health benefits over PRP for Indian patients with PDR, but at current prices it is not cost‑effective. Substantial reductions in drug cost or alternative reimbursement approaches would be needed for ranibizumab to represent value for money in the Indian setting.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE15
Topic
Economic Evaluation
Topic Subcategory
Trial-Based Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity), SDC: Sensory System Disorders (Ear, Eye, Dental, Skin)