Title: Economic Evaluation of Bevacizumab Versus Ranibizumab in Neovascular Age-Related Macular Degeneration in China
Abstract: To evaluate the cost-effectiveness of the off-label used bevacizumab versus ranibizumab for patients with neovascular age-related macular degeneration (AMD) in China. Two different Markov models were used separately to compare cost per quality-adjusted life year (QALY) of four strategies defined by drug (bevacizumab or ranibizumab) and dosing regimen (monthly or as needed) in patients with neovascular AMD in China’s health care system. The VA Range model defines the health states using visual acuity (VA), while the VA Change model defines the health states according to the degree of VA changes from the time when entering the model. Both models used a life time horizon with a cycle length of 3 months. Clinical data used in the models primarily came from the Comparison of AMD Treatment Trial (CATT), while the costs came from the financial department of a tertiary hospital in Beijing. In the base-case analyses, the bevacizumab as needed strategy had slightly lower QALYs (17.479 QALYs and 15.917 QALYs in the VA Range model and the VA Change model, respectively) but at much lower costs (CN¥88,341 and CN¥79,967 in the VA Range model and the VA Change model, respectively) compared with the other three strategies. In probabilistic sensitivity analyses in both models, the probabilities of bevacizumab strategies being more cost-effective than ranibizumab strategies exceeded 99% if the willingness-to-pay (WTP) threshold for a QALY was less than CN¥120,000. When the threshold was less than CN¥90,000 per QALY, bevacizumab as needed was the most cost-effective alternative. The bevacizumab as needed strategy was the most cost-effective strategy compared with the ranibizumab strategies in treating patients with neovascular AMD, if the WTP threshold is below CN¥90,000 per QALY in China. This much cheaper treatment can substantially reduce the burden to the Chinese aging society.