Bevacizumab more cost-effective for ROP than laser

San Francisco-Treating retinopathy of prematurity (ROP) has a great value in societal terms due to the potentially long lifespans ahead of these patients. However, a comparison of bevacizumab (Avastin, Genentech) and laser for treating ROP found that drug therapy was more cost effective than laser, even with extended follow-up periods, according to Michael J. Geske, MD.

The idea of comparing the cost-effectiveness of therapies is not new. The concept was previously first explored by Brown et al. (Pediatrics. 1999;104:e47), who found that the cost per quality-adjusted life-year (QALY) was very low-$1,801/QALY for cryotherapy and $678/QALY for laser compared with other treatments, such as left main coronary artery bypass surgery at $6,880/QALY and liver transplantation at $327,500/QALY.

A recent study (N Engl J Med. 2011;364:603-615) of the efficacy of intravitreal bevacizumab for stage 3+ ROP found that with ROP recurrence rate of zone 1 and zone 2 disease was significantly lower compared with that with conventional laser therapy.

However, according to Dr. Geske-an ophthalmology resident at the University of California San Francisco -substantially longer follow-up is required because of late disease recurrence in children treated with bevacizumab, which may negate the cost-effectiveness.

Dr. Geske and his colleague pursued treatment costs further in a study in which they compared the cost-effectiveness of bevacizumab and laser for treating ROP. Using their model, they found that for zone 1 ROP, the total estimated cost per patient of bevacizumab treatment, was $1,099.94, and $2,618.15 for laser. For zone 2 disease, the respective costs were $834 and $1,877.

Considering the late recurrence of ROP associated with bevacizumab, the investigators conducted a further analysis to determine the effect of prolonged follow-up requirements.

With a 50% increased duration of follow-up, bevacizumab remained more cost effective than laser for zones 1 ($1,519.89) and 2 ($1,156.82) disease. With a 100% increase in the duration of follow-up, the respective costs for zone 1 and 2 disease were $1,927.39 and $1,386.62.

“Treating ROP using any modality is cost effective from a societal standpoint,” Dr. Geske said. “Based on the currently available data, treating ROP with bevacizumab is relatively more cost effective than laser therapy. The caveat is that our model assumed identical outcomes and complications for both treatment groups.

“It will be instructive to repeat a cost-effectiveness analysis as long-term outcomes become available,” Dr. Geske concluded.

For more articles in this issue of Ophthalmology Times eReport, click here.

To receive weekly clinical news and updates in ophthalmology, subscribe to the Ophthalmology Times eReport.