OBJECTIVES

To evaluate the cost-effectiveness of anti-VEGF drugs (ranibizumab, aflibercept) and laser photocoagulation for the treatment of diabetic macular edema (DME) from Chinese societal perspective.

METHODS

A Markov model was constructed to simulate the long-term outcomes and costs in Chinese DME patients. Model health states were defined by the best-corrected visual acuity (BCVA) intervals ranging from ≤ 25 letters to 86-100 letters, with an extra absorbing state 'death'. Lifetime horizon was used, with a 3-month cycle length. Transition probabilities were calculated from the RESTORE clinical trial and published network meta-analysis. Health state utilities were estimated through literature, and costs were estimated from experts consultation of 6 hospitals in China and published literature.The primary outcomes of the model were costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Uncertainty was addressed via univariate and probabilistic sensitivity analyses.

RESULTS

Lifetime costs per patient of treating DME were ¥71,649 for ranibizumab, ¥93,702 for aflibercept, and ¥50,850 for laser photocoagulation; lifetime QALYs gained were 6.87 for ranibizumab, 6.84 for aflibercept, and 6.53 for laser photocoagulation. The ICER comparing ranibizumab with laser photocoagulation was ¥61,174/QALY, comparing aflibercept with laser photocoagulation was ¥138,232/QALY. Based on the generally accepted Chinese ICER threshold of ¥180,000/ QALY (3 times per-capita GDP, 2017 China), ranibizumab and aflibercept were found to be cost-effective compared with laser photocoagulation. Comparing ranibizumab with aflibercept, ranibizumab was the dominant therapy, with an incremental gain of 0.03 QALYs and cost savings of ¥22,053. Probabilistic sensitivity analyses showed ranibizumab had 72.1% and 84.7% probability, respectively, of being cost-effective relative to aflibercept and laser photocoagulation at a willingness-to-pay threshold of ¥180,000/ QALY.

CONCLUSIONS

From Chinese societal perspective, anti-VEGF drugs (ranibizumab, aflibercept) are the cost-effective therapies for the treatment of DME compared with laser photocoagulation，and ranibizumab is the dominant therapy when compared to aflibercept.