COST-EFFECTIVENESS ANALYSIS OF INTRAVITREAL AFLIBERCEPT VERSUS LASER PHOTOCOAGULATION AND RANIBIZUMAB IN THE TREATMENT OF VISUAL IMPAIRMENT DUE TO DIABETIC MACULAR EDEMA IN CHINA
Author(s)
Ming J1, Zhang Y2, Xu X3, Zhao M4, Wang Y5, Chen Y6, Zhang F7, Wang J7, Liu J1, Zhao X1, Han R8, Hu S9
1IQVIA, Shanghai, China, 2Humanities College, Shanghai Institute of Technology, Shanghai, China, 3Shanghai General Hospital, Shanghai, China, 4Peking University People’s Hospital, Beijing, China, 5Xijing Hospital, Fourth Military Medical University, Xi’an, China, 6Peking Union Medical College Hospital, Beijing, China, 7Beijing Tongren Hospital, Capital Medical University, Beijing, China, 8Bayer Healthcare Company Ltd., Beijing, China, 9Fudan University, Shanghai, China
Presentation Documents
OBJECTIVES : To conduct a cost-effective analysis to evaluate the long-term economic benefits of intravitreal aflibercept (IVT-AFL) versus macular laser and ranibizumab in the treatment of diabetic macular edema (DME) in China. METHODS : A Markov model was developed to compare IVT-AFL 2 mg every 8 weeks after 5 initial monthly doses versus macular laser and ranibizumab 0.5 mg pro-re-nata from a societal perspective. The model was condensed into an efficacy, maintenance, and non-intervention phase to reflect the vision changes in treated patients. Eight health states were defined based on the number of Early Treatment Diabetic Retinopathy Study letters read. Efficacy data were derived from the VIVID-EAST trial and published indirect comparison. Other parameters were estimated from the VIVID-EAST trial data, published literature, local reference price tables, or physician surveys. Productivity loss and caregiver cost were included. Univariate and probabilistic sensitivity analyses were conducted. RESULTS : In the base case of a 20-year lifetime horizon, an IVT-AFL-treated patient was associated with 7.825 quality-adjusted life years (QALYs) and 217,841 CNY (32,264 USD; average exchange rate 2017: 1 USD=6.75 CNY), a laser-treated patient was associated with 7.189 QALYs and 135,489 CNY (20,067 USD), and a ranibizumab-treated patient was associated with 7.462 QALYs and 222,477 CNY (32,951 USD). This analysis resulted in the incremental cost-effectiveness ratio of 129,397 CNY (19,165 USD) for IVT-AFL versus laser, and -12,774 CNY (-1,892 USD) for IVT-AFL versus ranibizumab. Probabilistic sensitivity analyses projected that IVT-AFL has a higher probability of being cost-effective compared to laser under the willingness-to-pay threshold (triple GDP per capita 178,980 CNY in China in 2017). When comparing to ranibizumab, IVT-AFL is dominant in most scenarios. CONCLUSIONS : In China, IVT-AFL can be considered a cost-effective strategy for the treatment of DME compared with laser and a dominant strategy providing better outcomes with lower cost compared with ranibizumab.
Conference/Value in Health Info
2019-11, ISPOR Europe 2019, Copenhagen, Denmark
Code
PDB44
Topic
Clinical Outcomes, Economic Evaluation
Topic Subcategory
Relating Intermediate to Long-term Outcomes, Trial-Based Economic Evaluation
Disease
Diabetes/Endocrine/Metabolic Disorders