SynthesisPloS one2018
The cost-effectiveness of bevacizumab, ranibizumab and aflibercept for the treatment of age-related macular degeneration-A cost-effectiveness analysis from a societal perspective.
Synthesis in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 2 of them syntheses that pooled 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.
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.
Who cites it
50 citing papers in PubMed, 2 syntheses or guidelines pooled it, 114 citations in OpenAlex.
- Direct randomized evidence comparing ranibizumab and bevacizumab for macular edema secondary to retinal vein occlusion: a systematic review and meta-analysis.BMC ophthalmology · 2026Pooled it
- The Effect of Dietary Supplementations on Delaying the Progression of Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis.Nutrients · 2022Pooled it
- Associations of Variation in Retinal Thickness With Visual Acuity and Anatomic Outcomes in Eyes With Neovascular Age-Related Macular Degeneration Lesions Treated With Anti-Vascular Endothelial Growth Factor Agents.JAMA ophthalmology · 2020Trial
- Adoption patterns of anti-vascular endothelial growth factor therapies in retinal disease.Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2026Article
- Retinopathy of prematurity screening and treatment practice patterns: an African multi-country survey.Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2026Article
- Understanding anti-vascular endothelial growth factor medications: chemical properties, costs, and side effects.Journal of medicine and life · 2026Review
- U.S. trends of anti-vascular endothelial growth factor use from 2017-2023: An analysis of medicare, medicaid, and commercial insurance.PloS one · 2026Article
- Off-label prescribing in ophthalmology: a retrospective analysis.Frontiers in pharmacology · 2026Article
- Early Fluctuations of Exudative Lesions as Predictors of Two-Year Clinical Outcomes in Neovascular Age-Related Macular Degeneration.Translational vision science & technology · 2025Article
- Efficacy, Safety, and Injection Frequency with Novel Aflibercept 8 mg in Neovascular Age-Related Macular Degeneration: A Comparison with Existing Anti-VEGF Regimens Using a Bayesian Network Meta-Analysis.Ophthalmology and therapy · 2025Article
- Estimating the costs and quality of life impact of vision loss in the population aged 50-80 years in Malta: evidence from The Malta Eye Study.Frontiers in public health · 2025Article
- Treatment results switching from aflibercept to bevacizumab in wet age-related macular degeneration.International journal of ophthalmology · 2025Article
- Global burden of low vision and blindness due to age-related macular degeneration from 1990 to 2021 and projections for 2050.BMC public health · 2024Article
- Aflibercept monotherapy or bevacizumab first for diabetic macular edema.Indian journal of ophthalmology · 2024Observational
- The impact of COVID-19 on aflibercept treatment of neovascular AMD in Sweden - data from the Swedish Macula Register.BMC ophthalmology · 2024Observational
- The Difference Method Approach for Sampling Order Constrained Parameters: An Improved Implementation and Important Limitations.PharmacoEconomics · 2024Article
- Effects of aflibercept and bevacizumab on cell viability, cell metabolism and inflammation in hypoxic human Müller cells.PloS one · 2024Article
- Patient-Centered Economic Burden of Exudative Age-Related Macular Degeneration: Retrospective Cohort Study.JMIR public health and surveillance · 2023Article
- Real-world evidence in the use of Bevacizumab in age-related macular degeneration (ArMD): a scoping review.International ophthalmology · 2023Article
- Short-term Efficacy and Safety of Intravitreal Brolucizumab Injection for Treatment-Naive Exudate Age-related Macular Degeneration: A Multicenter Study.Korean journal of ophthalmology : KJO · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe discussion on the use of bevacizumab is still ongoing and often doctors are deterred from using bevacizumab due to legal or political issues. Bevacizumab is an effective, safe and inexpensive treatment option for neovascular age-related macular degeneration (AMD), albeit unregistered for the disease. Therefore, in some countries ophthalmologists use the equally effective but expensive drugs ranibizumab and aflibercept. We describe the economic consequences of this dilemma surrounding AMD treatment from a societal perspective.
methodsWe modelled cost-effectiveness of treatment with ranibizumab (as-needed), aflibercept (bimonthly) and bevacizumab (as-needed). Effectiveness was estimated by systematic review and meta-analysis. The drug with the most favourable cost-effectiveness profile compared to bevacizumab was used for threshold analyses. First, we determined how much we overspend per injection. Second, we calculated the required effectiveness to justify the current price and the reasonable price for a drug leading to optimal vision. Finally, we estimated how much Europe overspends if bevacizumab is not first choice.
resultsBevacizumab treatment costs €27,087 per year, about €4,000 less than aflibercept and €6,000 less than ranibizumab. With similar effectiveness for all drugs as shown by meta-analysis, bevacizumab was the most cost-effective. Aflibercept was chosen for threshold analyses. Aflibercept costs €943 per injection, but we determined that the maximum price to be cost-effective is €533. Alternatively, at its current price, aflibercept should yield about twice the visual gain. Even when optimal vision can be achieved, the maximum price for any treatment is €37,453 per year. Most importantly, Europe overspends €335 million yearly on AMD treatment when choosing aflibercept over bevacizumab.
conclusionBevacizumab is the most cost-effective treatment for AMD, yet is not the standard of care across Europe. The registered drugs ranibizumab and aflibercept lead to large overspending without additional health benefits. Health authorities should consider taking steps to implement bevacizumab into clinical practice as first choice.
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Registered trials
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.