Title: PSS34 - COST-EFFECTIVENESS OF INTRAVITREAL AFLIBERCEPT VERSUS RANIBIZUMAB IN THE TREATMENT OF DIABETIC MACULAR EDEMA IN SPAIN
Abstract: Intravitreal aflibercept (IVT-AFL) and ranibizumab are anti-vascular endothelial growth factor (VEGF) agents licensed to treat visual impairment due to diabetic macular edema (DME). The aim of this analysis was to conduct a cost-utility analysis of IVT-AFL 2 mg versus ranibizumab 0.5 mg pro re nata (PRN) and ranibizumab 0.5 mg treat-and-extend (T&E) in the treatment of visual impairment due to DME in the Spanish healthcare setting. A Markov model was adapted to simulate outcomes and costs of treating DME over a 15-year time horizon. One-month cycles were defined as a function of visual acuity in both eyes within a total of 65 health states. The model was populated with data from the VIVID-DME/VISTA-DME studies for IVT-AFL, and with relative risks from an indirect comparison for ranibizumab PRN and T&E. Resource use (injection and monitoring frequencies) were informed from available data up to 5 years, reflecting as much as possible the Spanish practice. Future costs and health outcomes were discounted at 3% annually. The analysis was conducted from the Spanish National Health Service perspective, so direct healthcare costs were included (Official College of Pharmacists). The main outcome of the analysis was the incremental cost-effectiveness ratio of IVT-AFL compared with ranibizumab. Alternative scenario was tested using different injection frequency for IVT-AFL. IVT-AFL was a dominant alternative, resulting in lower costs and greater outcomes compared with both ranibizumab PRN and T&E: increment of 0.15 and 0.31 quality adjusted life-years (QALYs) versus ranibizumab PRN and T&E, respectively. IVT-AFL resulted in cost savings and better outcomes compared with ranibizumab PRN and T&E, indicating that it can be considered as an efficient alternative for DME patients in the Spanish healthcare setting.