Cost-effectiveness of Ranibizumab Vs. Dexamethasone Implant In Diabetic Macular Edema.

Ranibizumab and dexamethasone intravitrael(DEX) implant are authorised treatments for treatment of DME in Turkey. The objective of this study is to assess the cost-effectiveness of ranibizumab vs. dexamethasone implants in DME treatment with public payer’s perspective. Two studies are used for indirect comparison to calculate the relative efficacy of ranibizumab vs. DEX implant over 12 months with endpoints of BVCA gains:(i)RESTORE comparing ranibizumab vs. laser BVCA gains at month 12 (ii)MEAD comparing DEX implant vs sham injections BVCA gains at month 36. For months 12 to 36, the efficacy inputs are calibrated such that the trajectories of mean BCVA for the two comparators reflect those reported in RESTORE(extension) and MEAD respectively. Conservative transitions probabilities were imposed on the ranibizumab arm, such that mean BCVA sustains the~8 letters gain but no further gain is assumed. These efficacy inputs are then validated by the MAGGIORE head to head study of ranibizumab and DEX implant. MAGGIORE couldn’t be used as a primary source of efficacy as the %gains of 10(or15 letters) were not reported. Units of resource use and withdrawal rates are obtained from RESTORE and MEAD. Mean number of yearly injection frequency for ranibizumab was 7.0, 3.9, 2.9 for year 1, year 2 and year 3 respectively;while for DEX implant yearly injection frequency was 2.4 for all three years. Unit costs of resources were obtained by using national fees per service lists and discounted by 3.5% Mean BCVA change from baseline at year 3 with ranibizumab arm was 7.2 and with DEX implant arm was 2.5 points. Incremental cost of gaining an extra year without visual impairment by treating with ranibizumab rather than DEX implant is 11.339TL. Although conservative approach was pursued both in terms of efficacy for ranibizumab arm, incremental cost of gaining an extra year without visual impairment by treating with ranibizumab was negligible.