Cost-effectiveness sequential modeling of ranibizumab versus usual care in age-related macular degeneration

Aims To assess effectiveness, cost, and cost-effectiveness of ranibizumab versus the current medical practices of treating age-related macular degeneration in France. Methods A simulation decision framework over 1 year compared ranibizumab versus the usual care using two effectiveness criteria: the visual acuity improvement rate (greater than 15 letters on the ETDRS scale) and the rate of legal blindness avoided. Two decision trees included various sequences of current treatments, with or without ranibizumab. Results Ranibizumab appeared significantly more effective than the usual care (p < 0.001), providing greater treatment success rate of visual acuity improvement (48.8% versus 33.9%). The cost of the ranibizumab strategy was higher (9,123 euros ((sic)) over 1 year for ranibizumab versus 7,604 (sic) for the usual care) but the average cost-effectiveness was lower - 18,721 (sic) /success for ranibizumab versus 22,543 (sic)/success for usual care (p < 0.001). Considering the legal blindness avoided success criterion, the ranibizumab strategy appeared significantly more effective (p < 0.001), providing greater treatment success rate for of legal blindness avoided than usual care (99.7% versus 93.1%) although it was more expensive (9,196 (sic) over 1 year for ranibizumab versus 5,713 (sic) for the usual care). Conclusion Ranibizumab significantly improved the rate of visual acuity improvement and reduced the rate of legal blindness. Ranibizumab appeared significantly more cost-effective than the usual treatments in terms of visual acuity improvement.