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Kymes, Steven M.; Oden, Neal L.; VanVeldhuisen, Paul C.; Scott, Ingrid U.; Ip, Michael S.; Blodi, Barbara A.; King, Jacquie; Williams, George A; Abraham, Prema; Bement-Stump, Beth; Callahan, Leah; Dockter, Mindi; Livermont, Kristi; Nixon, Robert; Parks, Dan; Steinle, Nathan; Thompson, Alison; Yu, Dylan; Bailey, Steven; Barth, Jordan; Blefgen, Sara; Campbell, J. Peter; Flaxel, Christina; Fujisaki, Brad; [...]

Cost-Utility Comparison of Bevacizumab and Aflibercept in the Treatment of Central or Hemiretinal Vein Occlusion in the SCORE2 Trial

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  • Media type: E-Article
  • Title: Cost-Utility Comparison of Bevacizumab and Aflibercept in the Treatment of Central or Hemiretinal Vein Occlusion in the SCORE2 Trial
  • Contributor: Kymes, Steven M.; Oden, Neal L.; VanVeldhuisen, Paul C.; Scott, Ingrid U.; Ip, Michael S.; Blodi, Barbara A.; King, Jacquie; Williams, George A; Abraham, Prema; Bement-Stump, Beth; Callahan, Leah; Dockter, Mindi; Livermont, Kristi; Nixon, Robert; Parks, Dan; Steinle, Nathan; Thompson, Alison; Yu, Dylan; Bailey, Steven; Barth, Jordan; Blefgen, Sara; Campbell, J. Peter; Flaxel, Christina; Fujisaki, Brad; [...]
  • imprint: American Medical Association (AMA), 2023
  • Published in: JAMA Ophthalmology
  • Language: English
  • DOI: 10.1001/jamaophthalmol.2023.1463
  • ISSN: 2168-6165
  • Keywords: Ophthalmology
  • Origination:
  • Footnote:
  • Description: <jats:sec id="ab-eoi230019-4"><jats:title>Importance</jats:title><jats:p>Retinal vein occlusion is the second most common retinal vascular disease. Bevacizumab was demonstrated in the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) to be noninferior to aflibercept with respect to visual acuity in study participants with macular edema due to central retinal vein occlusion (CRVO) or hemiretinal vein occlusion (HRVO) following 6 months of therapy. In this study, the cost-utility of bevacizumab vs aflibercept for treatment of CRVO is evaluated.</jats:p></jats:sec><jats:sec id="ab-eoi230019-5"><jats:title>Objective</jats:title><jats:p>To investigate the relative cost-effectiveness of bevacizumab vs aflibercept for treatment of macular edema associated with CRVO or HRVO.</jats:p></jats:sec><jats:sec id="ab-eoi230019-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>This economic evaluation study used a microsimulation cohort of patients with clinical and demographic characteristics similar to those of SCORE2 participants and a Markov process. Parameters were estimated and validated using a split-sample approach of the SCORE2 population. The simulated cohort included 5000 patients who were evaluated 100 times, each with a different set of characteristics randomly selected based on the SCORE2 trial. SCORE2 data were collected from September 2014 October 2019, and data were analyzed from October 2019 to July 2021.</jats:p></jats:sec><jats:sec id="ab-eoi230019-7"><jats:title>Interventions</jats:title><jats:p>Bevacizumab (followed by aflibercept among patients with a protocol-defined poor or marginal response to bevacizumab at month 6) vs aflibercept (followed by a dexamethasone implant among patients with a protocol-defined poor or marginal response to aflibercept at month 6).</jats:p></jats:sec><jats:sec id="ab-eoi230019-8"><jats:title>Main Outcomes and Measures</jats:title><jats:p>Incremental cost-utility ratio.</jats:p></jats:sec><jats:sec id="ab-eoi230019-9"><jats:title>Results</jats:title><jats:p>The simulation demonstrated that patients treated with aflibercept will have an expected cost $18 127 greater than those treated with bevacizumab in the year following initiation. When coupled with the lack of clinical superiority over bevacizumab (ie, patients treated with bevacizumab had a gain over aflibercept in visual acuity letter score of 4 in the treated eye and 2 in the fellow eye), these results demonstrate that first-line treatment with bevacizumab dominated aflibercept in the simulated cohort of SCORE2 participants. At current price levels, aflibercept would be considered the preferred cost-effective option only if treatment restored the patient to nearly perfect health.</jats:p></jats:sec><jats:sec id="ab-eoi230019-10"><jats:title>Conclusions and Relevance</jats:title><jats:p>While there will be some patients with CRVO-associated or HRVO-associated macular edema who will benefit from first-line treatment with aflibercept rather than bevacizumab, given the minimal differences in visual acuity outcomes and large cost differences for bevacizumab vs aflibercept, first-line treatment with bevacizumab is cost-effective for this condition.</jats:p></jats:sec>