The cost-effectiveness of bevacizumab, ranibizumab and aflibercept for the treatment of age-related macular degeneration-A cost-effectiveness analysis from a societal perspective.
The cost-effectiveness of bevacizumab, ranibizumab and aflibercept for the treatment of age-related macular degeneration-A cost-effectiveness analysis from a societal perspective.
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DOI：
10.1371/journal.pone.0197670
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Grutters JPC
中科院分区：
文献类型：
--
作者：
van Asten F;Michels CTJ;Hoyng CB;van der Wilt GJ;Klevering BJ;Rovers MM;Grutters JPC
关于贝伐单抗使用的讨论仍在进行中，由于法律或政治问题，医生经常被阻止使用贝伐单抗。贝伐单抗是一种有效、安全和廉价的治疗新血管性年龄相关性黄斑变性（AMD）的选择，尽管未注册用于该疾病。因此，在一些国家，眼科医生使用同样有效但昂贵的药物雷尼珠单抗和阿非利塞普。我们从社会的角度描述了这种困境的经济后果周围AMD治疗。我们模拟了雷尼单抗（按需）、阿非利西普（每两个月一次）和贝伐单抗（按需）治疗的成本效益。通过系统评价和荟萃分析评估疗效。与贝伐单抗相比，具有最有利成本效益的药物用于阈值分析。首先，我们确定每次注射超支多少。其次，我们计算了所需的有效性，以证明当前价格和导致最佳视力的药物的合理价格是合理的。最后，我们估计了如果贝伐单抗不是首选，欧洲超支的金额。贝伐单抗每年的治疗费用为27,087欧元，比阿非利赛普低约4,000欧元，比雷尼单抗低6,000欧元。荟萃分析显示，所有药物的疗效相似，贝伐单抗是最具成本效益的。阈值分析选择afliberept。Aflibercept每次注射的成本为943欧元，但我们确定具有成本效益的最高价格为533欧元。或者，以目前的价格，afliberept应该产生大约两倍的视觉增益。即使可以达到最佳视力，任何治疗的最高价格也是每年37,453欧元。最重要的是，欧洲每年在AMD治疗上多花了3.35亿欧元，因为他们选择了阿非利赛普而不是贝伐单抗。贝伐单抗是AMD最具成本效益的治疗方法，但在整个欧洲并不是标准的治疗方法。注册药物雷尼珠单抗和阿非利赛普导致大量超支，但没有额外的健康益处。卫生当局应考虑采取措施，将贝伐单抗作为临床实践的首选。
The discussion on the use of bevacizumab is still ongoing and often doctors are deterred from using bevacizumab due to legal or political issues. Bevacizumab is an effective, safe and inexpensive treatment option for neovascular age-related macular degeneration (AMD), albeit unregistered for the disease. Therefore, in some countries ophthalmologists use the equally effective but expensive drugs ranibizumab and aflibercept. We describe the economic consequences of this dilemma surrounding AMD treatment from a societal perspective. We modelled cost-effectiveness of treatment with ranibizumab (as-needed), aflibercept (bimonthly) and bevacizumab (as-needed). Effectiveness was estimated by systematic review and meta-analysis. The drug with the most favourable cost-effectiveness profile compared to bevacizumab was used for threshold analyses. First, we determined how much we overspend per injection. Second, we calculated the required effectiveness to justify the current price and the reasonable price for a drug leading to optimal vision. Finally, we estimated how much Europe overspends if bevacizumab is not first choice. Bevacizumab treatment costs €27,087 per year, about €4,000 less than aflibercept and €6,000 less than ranibizumab. With similar effectiveness for all drugs as shown by meta-analysis, bevacizumab was the most cost-effective. Aflibercept was chosen for threshold analyses. Aflibercept costs €943 per injection, but we determined that the maximum price to be cost-effective is €533. Alternatively, at its current price, aflibercept should yield about twice the visual gain. Even when optimal vision can be achieved, the maximum price for any treatment is €37,453 per year. Most importantly, Europe overspends €335 million yearly on AMD treatment when choosing aflibercept over bevacizumab. Bevacizumab is the most cost-effective treatment for AMD, yet is not the standard of care across Europe. The registered drugs ranibizumab and aflibercept lead to large overspending without additional health benefits. Health authorities should consider taking steps to implement bevacizumab into clinical practice as first choice.
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作者：
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