09 Jun Severe Diabetic Macular Edema: EYLEA® Had Better Outcomes Than Avastin® or Lucentis® At One Year, But at Much Greater Cost
Adam Glassman
MedicalResearch.com Interview with:
Adam Glassman, M.S.
Director, DRCRnet Coordinating Center
Jaeb Center for Health Research
Tampa, FL 33647
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Diabetic macular edema (DME) is the most common cause of vision loss in patients with diabetes, impairing the vision of approximately 750,000 people in the United States. The most common treatment involves the injection into the eye of one of 3 drugs that inhibit vascular endothelial growth factor (VEGF). The Diabetic Retinopathy Clinical Research Network, funded by the National Institutes of Health, conducted a randomized clinical trial on the comparative effectiveness of the 3 anti-VEGF drugs EYLEA®, Avastin®, or Lucentis® for eyes with decreased vision from diabetic macular edema. There are substantial cost differences between the three drugs. In the United States, EYLEA® costs approximately $1850, repackaged (compounded) Avastin® $60, and Lucentis® $1170 per injection. In eyes with relatively good starting vision, there were no differences in vision outcomes; all three groups, on average, had improved vision. In eyes with starting vision of 20/50 or worse, EYLEA® had better vision outcomes at 1 year than either Avastin® or Lucentis®, and better vision outcomes at 2 years than Avastin®. However, given that, on average, eyes will receive 9 to 10 injections within the first year of treatment and 5 injections in the second year, neither EYLEA® nor Lucentis® would be considered cost effective by standard benchmarks compared with Avastin® unless their prices decrease substantially.
MedicalResearch.com: What should readers take away from your report?
Response: The results from this study will help clinicians and patients make decision on how to manage diabetic macular edema. However, ultimately the decision of which agent to use is going to be based on a number of factors including efficacy, safety, cost and insurance coverage. These results highlight the challenges that physicians, patients, and policymakers face when efficacy results like vision outcomes are at odds with cost-effectiveness results.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: It would be interesting to know if results would be similar for eyes with diabetic macular edema and vision of 20/50 or worse treated with EYLEA® initially compared to starting with Avastin and only administering Eylea if the Avastin did not work for the patient. If the results of those two approaches resulted in similar efficacy and safety then a significant cost saving might be identified. However, without data it is unknown at the current time the implications of this approach.
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Citation:
Eric L. Ross, BA et al. Cost-effectiveness of Aflibercept, Bevacizumab, and Ranibizumab for Diabetic Macular Edema Treatment: Analysis From the Diabetic Retinopathy Clinical Research Network Comparative Effectiveness Trial. JAMA Ophthalmol, June 2016 DOI:10.1001/jamaophthalmol.2016.1669
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
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Last Updated on June 9, 2016 by Marie Benz MD FAAD