OBJECTIVES

To evaluate the cost-effectiveness of ranibizumab compared with laser photocoagulation or no treatment (observation) in patients with macular edema secondary to branch retinal vein occlusion (BRVO-ME) and macular edema secondary to central retinal vein occlusion (CRVO-ME), respectively, from the Chinese societal perspective.

METHODS

A Markov model was constructed to simulate the long-term outcomes and costs of Chinese BRVO-ME and CRVO-ME patients. Model health states were defined by increments of 10 letters in best corrected visual acuity (BCVA) ranging from ≤ 25 letters to 86-100 letters, with an extra absorbing state 'death'. Lifetime horizon was used, with a 1-month cycle length. Transition probabilities were calculated from the BLOSSOM clinical trial and CAMELLIA clinical trial. 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

For BRVO-ME patients, lifetime costs of ranibizumab and laser photocoagulation were ¥80,834 and ¥44,799, respectively; lifetime QALYs gained were 8.95 and 8.31, respectively. Adopting a willingness to pay of ¥180,000/ QALY (3 times per-capita GDP, 2017 China) as the threshold, ranibizumab was found to be cost-effective compared with laser photocoagulation, with the ICER of ¥56,303/QALY. For CRVO-ME patients, lifetime costs of ranibizumab and observation were ¥120,246 and ¥117,757, respectively; lifetime QALYs gained were 9.48 and 8.93, respectively. Ranibizumab was found to be cost-effective compared with observation, with the ICER of ¥4,525/QALY. Univariate and probabilistic sensitivity analysis demonstrated the robustness of the results.

CONCLUSIONS

From Chinese societal perspective, ranibizumab is the cost-effective therapy for both the treatment of BRVO-ME and CRVO-ME when compared to laser photocoagulation and observation, respectively.