Study: Europe Is Overspending on AMD Treatment by Not Using Bevacizumab

In a new paper, researchers sought to describe how much the European Union is overspending on neovascular age-related macular degeneration treatment by relying on ranibizumab and aflibercept rather than bevacizumab in ophthalmology.
Kelly Davio
May 29, 2018
Bevacizumab represents an effective and relatively inexpensive anti–vascular endothelial growth factor (anti-VEGF) treatment for neovascular age-related macular degeneration (AMD), but because it is not approved for this indication, many physicians are discouraged from using bevacizumab to treat AMD. Even the United Kingdom’s National Institute for Health and Care Excellence (NICE) recommends using the more expensive anti-VEGF treatments ranibizumab or aflibercept to treat this disease.

In a new paper in PLOS One, researchers sought to describe how much the European Union is overspending on AMD treatment by relying on ranibizumab and aflibercept rather than bevacizumab in ophthalmology.

The researchers developed a patient-level decision analytic model to evaluate effectiveness, quality of life, and costs to compare ranibizumab used as needed and aflibercept administered bimonthly with bevacizumab used as needed. The model estimated the mean costs and benefits for a hypothetical group over a 1-year time horizon. To determine effectiveness of each drug, the researchers used a systematic review and meta-analysis of the literature. Costs were calculated from a societal perspective, including direct costs (including drug costs, medical visits, and examinations) and indirect costs (including the costs of low vision aids and nonmedical costs). They used a willingness-to-pay (WTP) threshold of €80,000 (approximately $93,325) per quality-adjusted life year (QALY). Overspending was defined as the amount of extra money paid for health care that cannot be justified by the WTP threshold of €80,000.

The researchers found:
  • Bevacizumab was the most cost-effective treatment in 100% of simulations.
  • Aflibercept yielded only 0.015 extra QALYs versus bevacizumab.
  • Using aflibercept rather than bevacizumab would mean paying €278,099 (approximately $324,486) per QALY gained 
They also compared aflibercept with bevacizumab to demonstrate what would be needed for it to be a justifiable alternative to bevacizumab, and found that aflibercept should be reduced from €943 (approximately $1100) to €533 (approximately $622) per injection. If aflibercept were to meet the WTP threshold practiced by NICE, it would have to be discounted to €447 (approximately $522) per injection. Alternatively, at its current price, aflibercept should provide at least an additional 0.041 QALYs per patient versus bevacizumab.

The United Kingdom alone, write the authors, is overspending by €52.5 million (approximately $60.6 million) annually. Europe as a whole could save €335 million (approximately $386 million) yearly by treating 80% of people with AMD with bevacizumab rather than aflibercept.

“The awareness of the importance of cost-effectiveness to keep health care sustainable is growing and new drugs should be critically appraised on their added value,” write the authors. “In the case of neovascular AMD treatment there is no question; bevacizumab is the most cost-effective anti-VEGF treatment for AMD.”

van Asten F, Michels CTJ, Hyong CB, et al. The cost-effectiveness of bevacizumab, ranibizumab and aflibercept for the treatment of age-related macular degeneration—a cost-effectiveness analysis from a societal perspective. [Published online May 17, 2018.] PLoS One. doi: 10.1371/journal.pone.0197670.



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