Evidence map›Paper›PMID 25079928›Full record

Trial reportBMJ open2014

Cost-effectiveness of ranibizumab and bevacizumab for age-related macular degeneration: 2-year findings from the IVAN randomised trial.

Helen A Dakin, Sarah Wordsworth, Chris A Rogers, Giselle Abangma, James Raftery, Simon P Harding, Andrew J Lotery, Susan M Downes, Usha Chakravarthy, Barnaby C Reeves and 1 more

Open access · goldAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ open, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
31citing papers in PubMed, 4 pooled it
10.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

31 citing papers in PubMed, 4 syntheses or guidelines pooled it, 81 citations in OpenAlex.

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  12. AAV2-antiVEGFscFv gene therapy for retinal neovascularization.Molecular therapy. Methods & clinical development · 2023
    Article
  13. Treatment of neovascular age-related macular degeneration: insights into drug-switch real-world from the Berlin Macular Registry.Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2023
    Article
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  16. Cost-minimisation analysis of a treat-and-extend regimen with anti-VEGFs in patients with neovascular age-related macular degeneration.Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2022
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 7 institutions in 2 countries.

Helen A DakinNuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK.
Sarah WordsworthNuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK.
Chris A RogersClinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
Giselle AbangmaSwiss Re Services Ltd, Research and Development, London, UK.
James RafteryPrimary Care & Population Sciences, University of Southampton, Southampton, UK.
Simon P HardingDepartment of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
Andrew J LoteryAcademic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
Susan M DownesOxford Eye Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
Usha ChakravarthyCentre for Experimental Medicine, The Queen's University of Belfast, Belfast, UK.
Barnaby C ReevesClinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
IVAN Study Investigators
University of Bristol · GBUniversity of Oxford · GBUniversity of Southampton · GBOxford University Hospitals NHS Trust · GBQueen's University Belfast · GBSwiss Re (Switzerland) · CHUniversity of Liverpool · GB

Funding

Department of Health 07/36/01Medical Research Council MR/K025643/1
6 · The paper itself

Abstract

objectiveTo assess the incremental cost and cost-effectiveness of continuous and discontinuous regimens of bevacizumab (Avastin) and ranibizumab (Lucentis) for neovascular age-related macular degeneration (nAMD) from a UK National Health Service (NHS) perspective.

designA within-trial cost-utility analysis with a 2-year time horizon, based on a multicentre factorial, non-inferiority randomised controlled trial.

setting23 hospital ophthalmology clinics.

participants610 patients aged ≥50 years with untreated nAMD in the study eye.

interventions0.5 mg ranibizumab or 1.25 mg bevacizumab given continuously (monthly) or discontinuously (as-needed) for 2 years.

main outcome measuresQuality-adjusted life-years (QALYs).

resultsTotal 2-year costs ranged from £3002/patient ($4700; 95% CI £2601 to £3403) for discontinuous bevacizumab to £18 590/patient ($29 106; 95% CI £18 258 to £18 922) for continuous ranibizumab. Ranibizumab was significantly more costly than bevacizumab for both continuous (+£14 989/patient ($23 468); 95% CI £14 522 to £15 456; p<0.001) and discontinuous treatment (+£8498 ($13 305); 95% CI £7700 to £9295; p<0.001), with negligible difference in QALYs. Continuous ranibizumab would only be cost-effective compared with continuous bevacizumab if the NHS were willing to pay £3.5 million ($5.5 million) per additional QALY gained. Patients receiving continuous bevacizumab accrued higher total costs (+£599 ($938); 95% CI £91 to £1107; p=0.021) than those receiving discontinuous bevacizumab, but also accrued non-significantly more QALYs (+0.020; 95% CI -0.032 to 0.071; p=0.452). Continuous bevacizumab therefore cost £30 220 ($47 316) per QALY gained versus discontinuous bevacizumab. However, bootstrapping demonstrated that if the NHS is willing to pay £20 000/QALY gained, there is a 37% chance that continuous bevacizumab is cost-effective versus discontinuous bevacizumab.

conclusionsRanibizumab is not cost-effective compared with bevacizumab, being substantially more costly and producing little or no QALY gain. Discontinuous bevacizumab is likely to be the most cost-effective of the four treatment strategies evaluated in this UK trial, although there is a 37% chance that continuous bevacizumab is cost-effective. TRIAL REGISTRATION NUMBER: ISRCTN92166560.

Indexed as

AgedAged, 80 and overAngiogenesis InhibitorsAntibodies, Monoclonal, HumanizedBevacizumabCost-Benefit AnalysisDrug CostsFemaleHealth Care CostsHumansMacular DegenerationMaleMiddle AgedQuality-Adjusted Life YearsRanibizumabRegression AnalysisAngiogenesis InhibitorsAntibodies, Monoclonal, HumanizedBevacizumabRanibizumabcost-effectivenesscost-minimisation analysiscost-utility analysisNeovascular age-related macular degeneration (AMD)trial-based economic evaluationvascular endothelial growth factor (VEGF) inhibitors

Identifiers

PMID25079928
PMCPMC4120317
OpenAlexW2126693257

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.