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Original Investigation
June 2017

Cost-effectiveness of Intravitreous Ranibizumab Compared With Panretinal Photocoagulation for Proliferative Diabetic RetinopathySecondary Analysis From a Diabetic Retinopathy Clinical Research Network Randomized Clinical Trial

Author Affiliations
  • 1Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
  • 2Department of Industrial and Operations Engineering, University of Michigan College of Engineering, Ann Arbor
  • 3Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
  • 4Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor
  • 5Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 6Editor, JAMA Ophthalmology
  • 7Feinberg School of Medicine, Northwestern University, Chicago, Illinois
  • 8Charlotte Eye, Ear, Nose, and Throat Associates, Charlotte, North Carolina
  • 9Jaeb Center for Health Research, Tampa, Florida
JAMA Ophthalmol. 2017;135(6):576-584. doi:10.1001/jamaophthalmol.2017.0837
Key Points

Question  What are the incremental cost-effectiveness ratios of 0.5-mg ranibizumab therapy to panretinal photocoagulation for proliferative diabetic retinopathy?

Findings  This preplanned secondary analysis of a randomized clinical trial found that for participants with and without baseline vision-impairing diabetic macular edema, the incremental cost-effectiveness ratios of ranibizumab therapy compared with panretinal photocoagulation were $55 568/quality-adjusted life-year and $662 978/quality-adjusted life-year, respectively, over 2 years.

Meaning  Compared with panretinal photocoagulation, 0.5-mg ranibizumab was cost-effective for eyes presenting with proliferative diabetic retinopathy and vision-impairing diabetic macular edema but not for those with proliferative diabetic retinopathy without vision-impairing diabetic macular edema.

Abstract

Importance  The Diabetic Retinopathy Clinical Research Network Protocol S randomized clinical trial results suggest that ranibizumab is a reasonable treatment alternative to panretinal photocoagulation (PRP) when managing proliferative diabetic retinopathy (PDR), with or without concomitant baseline diabetic macular edema (DME). However, ranibizumab injections are costly. Thus, it would be useful to examine the relative cost-effectiveness of these 2 treatment modalities.

Objective  To evaluate incremental cost-effectiveness ratios of 0.5-mg ranibizumab therapy vs PRP for PDR.

Design, Setting, and Participants  Preplanned secondary analysis using efficacy, safety, and resource utilization data through 2 years of follow-up at 55 US sites for 213 adults with PDR. Data were collected from February 2012 to January 2015.

Interventions  Intravitreous 0.5-mg ranibizumab at baseline and as frequently as every 4 weeks based on a structured retreatment protocol or PRP at baseline for PDR. Eyes in both groups could receive ranibizumab for concomitant DME.

Main Outcomes and Measures  Incremental cost-effectiveness ratios of ranibizumab compared with PRP evaluated within 2 prespecified subgroups for the study eye: with baseline vision-impairing (Snellen equivalent 20/32 or worse) DME and without baseline vision-impairing DME.

Results  The study included 305 adults with PDR, the mean age was 52 years, 44% were women, and 52% were white. Of the 46 participants with PDR and vision-impairing DME at baseline, 21 were assigned to the ranibizumab group and 25 to the PRP group (plus ranibizumab for DME). Among the remaining participants without baseline vision-impairing DME, 80 and 87 were in the ranibizumab and PRP groups, respectively. For participants with and without baseline vision-impairing DME, the incremental cost-effectiveness ratios of ranibizumab therapy compared with PRP were $55 568/quality-adjusted life-year and $662 978/quality-adjusted life-year, respectively, over 2 years.

Conclusions and Relevance  Over 2 years, compared with PRP, 0.5-mg ranibizumab as given in this trial is within the $50 000/quality-adjusted life-year to $150 000/quality-adjusted life-year range frequently cited as cost-effective in the United States for eyes presenting with PDR and vision-impairing DME, but not for those with PDR without vision-impairing DME.

Trial Registration  Clinicaltrials.gov Identifier: NCT01489189.

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