Age-related macular degeneration
Ranibizumab and Pegaptanib
Background to the April 2012 report
The DSU was asked to establish whether a proposed revision to the patient access scheme for ranibizumab in the treatment of age-related macular degeneration, would have an adverse impact on the cost-effectiveness estimates used in the development of Technology Appraisal 155. The DSU concluded that it was unlikely that the revised PAS scheme would have an adverse impact on the expected cost-effectiveness of ranibizumab.
Background to the September 2007 report
Following the Appraisal Committee meeting on 8 May 2007, a consultation document with preliminary recommendations was issued. Ranibizumab was recommended for the treatment of wet AMD for people with a confirmed diagnosis of predominantly classic lesions, only for the better-seeing of two affected eyes. Pegaptanib was not recommended for treatment of wet AMD. One of the issues raised during consultation was that pegaptanib may be more clinically- and cost- effective when used to treat a subgroup of patients with early stage disease.
In the submission by Pfizer, the manufacturer of pegaptanib, a range of incremental cost-effectiveness ratios (ICERs) was presented, for groups of patients stratified by initial levels visual acuity. The Pfizer model is based on patient-level data and is structurally different to the Assessment Group (AG) model.
The Decision Support Unit (DSU) were therefore requested to produce cost-effectiveness estimates from the Pfizer model using alternative parameter assumptions in order to enable consideration of the subgroups by initial visual acuity, but with a range of parameter assumptions consistent with those applied in the original AG model. Additional analyses based on the Pfizer model were also requested to match the assumptions being used in the revised analysis being undertaken by the AG.