“price effective” fun

Ophtalmology just published a cost-effectiveness comparison for treating diabetic macular edema comparing {ranibizumab + laser}, {triamcinolone + laser} and laser alone. Authors’ mathematical simulation shows that eyesight is better preserved for the same money when ranibizumab (brand name Lucentis) is used rather than the cheap, generic triamcinolone.

The elephant in the room is of course bevacizumab (brand name Avastin) which was not part of this comparison. Avastin is 30 times cheaper than Lucentis and the two have been found to be equally effective in treating diabetic macular edema on the relevant outcome, eyesight, used in the current analysis. Manufacturer-sponsored studies show that Avastin carries a higher risk of death than Lucentis, but the company has essentially failed to push the more expensive option in UK, where costs are better controlled than elsewhere.

Unsurprisingly, the disclosure sounds as follows:  “This project was completed by Dr. Dewan as part of his research elective as a fourth-year medical student at Washington University School of Medicine (WUSM). No funding was received from any source for support of this project. [...] Dr. Kymes receives research support from Genentech and Pfizer. He acts as a consultant for Pfizer, Allergan, Genentech, and TreeAge (maker of the software used in this project). Dr. Apte acts as a consultant for Genentech, Eyetech, Allergan, Ophthotech, Alimera, Regeneron, and Baxter.” Roche owns Genentech and sells both Avastin and Lucentis.

More unsurprisingly, the Medscape story title is “Diabetic Macular Edema: Pricey Option May Be Cost-Effective”.

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