Cost-Utility Comparison of Bevacizumab and Aflibercept in the Treatment of Central or Hemiretinal Vein Occlusion in the SCORE2 Trial
Authors: Kymes Steven M. , Oden Neal L. , VanVeldhuisen Paul C. , Scott Ingrid U. , Ip Michael S. , Blodi Barbara A. , King Jacquie ,   SCORE2 Investigator Group, Williams George A , Abraham Prema , Bement-Stump Beth , Callahan Leah , Dockter Mindi , Livermont Kristi , Nixon Robert , Parks Dan , Steinle Nathan , Thompson Alison , Yu Dylan , Bailey Steven , Barth Jordan , Blefgen Sara , Campbell J. Peter , Flaxel Christina , Fujisaki Brad , Howell Christopher , Hui Jocelyn , Hwang Thomas , Ira Shirley , Lauer Andreas , Liming Jeanne , Lindblad Phoebe , Lundquist Anne , Mistretta Frank , Nolte Susan , Petrolati Jennifer , Pickell Scott , Ryan Dawn , Schain Mitchell , Steinkamp Peter , Ukachukwu Chiedozie , Berger Adam , Darby Erika , Dilts Vera , Hamilton Richard , Holm Laura , McCarty Tammy , Medina Esmeralda , Misch David , Moon Suk J , Owen Kari , Randolph John , Strickland Jason , Sutherland Dawn , Tolentino Michael , Varner Nicole , Antoszyk Andrew , Balasubramaniam Uma , Bojaj Swann , Browning David , Clark Loraine , Ennis Sarah , Finch Autumn , Fleming Christina , Fredenberg Sherry , Gentile Angie , Jackson Lisa , McClain Donna , McOwen Michael , Price Angela , Punjabi Omar , Rowland Beverly , Watson Lynn , Bloom Ellis , Catapano Thomas , Chornobai Mariia , Hollimon Nicole , Hu Allen , King Donna , McChancy Christa , McCullough Wendy , Miller Kristen , Sanborn George , Sesay Ejiatu , Shetler Veronica , Smith Paula , Varner Becca , Wallech Leslee , Ward Shayla , Warrow David , Wenger Cherie , Wentz Alison , Wood Kimberly , Wroblewski John , Almeida Shannon , Bergman Vanessa , Booth Joann , Bradford Reagan , Brewer Alisha , Burris Russ , Butt Mandi , Drummond Vanessa , Fransen Stephen , Icks Sonny , Kingsley Ronald , Leonard Robert , Miller Heather , Shah Vinay , Wolzen Vicki , Bayer Krista , Eggert Lorraine , Geraghty Susan , Harper Morgan , Ie Darmakusuma , Knezek Lauren , Lipkowitz Jeffrey , Sannazzaro Beverly , Shah Kekul , Sadda Srinivas R , Balakrishnan Renjini , Bano Fazilla , Brinton Daniel , Bustamante Denise , Casugay Elyssa , Casupanan Roby , Chung Patty , Enyart Heather , Frambach Caroline , Jackson Khaliah , Jamali Afsoon , Kwan Mae , Lee Scott , Lit Eugene , Machacon Joshua , Madrigal Patty , Renslow Scotty , Ricks Helen , Rofagha Soraya , Winje Heidi , Belz Jennifer , Cain Theresa , Coffey Teresa , Davis Ashley , Elman Michael , Leder Henry , Metzger Ashley , Orr Peggy , Sandler Dallas , Simmons Jennifer , Simpson Perel , Singletary Pamela , Sotirakos Peter , Starr JoAnn , Thompson Amy , Brower Judy , Cribbs Blaine , Curtis Linda , Dobbs Jannah , Gibbs Deborah , Hendrick Andrew , Hubbard G. Baker , Jordan Debbie , Leef Donna , Middleton Darien , O'Keefe Ghazala , Olson Timothy , Pearson Samillya , Raeber Matthew , Robinson Joshua , Rogers Susan , Yan Jiong , Andrews Jackie , Carlton Steve , Dawson Katrina , Fagan Damanda , Friedman Scott , Marsh Tammi , McKinney Allen , Moinfar Nader , Seyez Karen , Walters Paige , Wendel Ceara , Williamson Kimberly , Domalpally Amitha , Reed Susan , Vargo Pamela , Jones Jini , Jones Leslie , Lampert Scott , Marcus Leslie , Mukkamala Krishna , Neal Lindsey , Nunn Lauren , Rogers Maria , Sharma Atul , Stoltz Robert , West Morgan , Allis Megan , Benvenutti Celia , Burley David , Desai Uday , Edwards Paul , Gao Hua , Grybas John , Gutkowski Melanie , Hall Julianne , Hessburg Thomas , Kumar Nitin , Massu Nicole , Mazurek Melina , Monk Mary , Murphy Janet , Nelson Jessica , Oude-Reimerink Dina , Rusinek Brian , Shaheen Jenny , Staffne Jessica , Stern Bradley , Troszak Tracey , Ventimiglia Katie , Carrasquillo-Boyd Wanda , Chui Yuen Ping , Gentile Ronald , Mehta Priya , Rivas Melissa , Rosen Richard , Soo Choi John Bo , Tai Katy , Tan Jia , Unson Meliza , Whitten Paul , Yang Alex , Carroll Catherine , Chau Felix , Janowicz Mark , Johnson Tametha , Leiderman Yannek , Lim Jennifer , Niec Marcia , Ovando Yesenia , Reyes Kevin , Stankovic Natasa , Sun Jie , Talasnik Lauren , Ulanski Lawrence , Reed Cynthia , Assissini Armand , Cerdenio Marvyn , Fan Joseph , Hernandez Raquel , Huang Lynn , Kiernan William , Knabb Jesse , Rauser Michael , Santiago Gisela , Suthar Mukesh , Williams Brandon , Chitjian Michael , DAmore Kristen , Deramo Vincent , Fastenberg David , Ferrone Philip , Golub Barry , Graham Kenneth , Jaya Sandra , Jonisch Jonathan , Rhee David , Romero Juan , Rosenblatt Brett , Schlameuss Marianne , Shakin Jeffrey , Shakin Eric , Sookhai Vasanti , Szczepanski Jamie , Baker Betsy , Bakri Sophie , Barkmeier Andrew , Burrington Jean , Currie Gillian , Franzen Melissa , Goddard Shannon , Lewison Denise , Morgan Jessica , Nielsen Rebecca , Overend Joan , Rubin Heidi , Smith Wendy , Tesmer Jamie , Thatcher Stephanie , Vogen Diane , Bell Darren , Bolado Carrisa , Burns Jason , Dominguez Melissa , Ellis Catherine , Escobar Rosa , Evans Richard , Goel Shelli , Gomez Roxanne , Huron Felicia , Montoya Guillermo , Myrick Cynthia , Rittimann Judy , Segovia Vincent , Singer Michael , Barwick Vicki , Beringer Joe , Carroll Joseph , Connor Thomas , Dorsey Eleanor , Goldberg Mara , Han Dennis P , Keller Kristy , Kim Judy , McKenney Katie , Moebius Stephanie , Packard Krissa , Stepien Kimberly , Weinberg David , Williams Vesper , Winter Pat , Wirostko William , Benfield Hannah , Centinaro Christina , Chiang Allen , Devine Lauren , Fineman Mitchell , Formoso Michele , Garg Sunir , George Cedric , Gonzales Elaine , Grande Lisa , Gupta Omesh , Ho Allen , Houston Samuel , Hsu Jason , Jay Maryann , Kaiser Richard , Kenney Brianna , Lavetsky Lisa , Listner Theresa , Maguire Joseph , Mehta Sonia , Noble Jill , Park Carl , Rahimy Ehsan , Reed David , Regillo Carl , Senderowitsch Noga , Sivalingam Arunan , Spirn Marc , Sudler Jamilla , Ciulla Thomas , Dale Tammy , Finnen Neil , Harris Charlotte , Hood Cindi , Kerr Ingrid , Maturi Raj , Phillips Kristin , Radtke Ashley , Robson Shyla , Sink Bethany , Steele Tom , Ghuman A. Thomas , Greenhoe Laura , Kiesel Cheryl , Kiesel Ray , Knips Eileen , Leslie Anita , Maro Kristi , Peters Crystal , Raskauskas Paul , Ryan Cheryl , Saez Jessica Lynn , Sharma Ashish , Torres (Crawford) Natalie , Turnbo Danielle , Walker Joseph , Wing Glenn , Berezina Tamara , Bhagat Neelakshi , Boschert Kathryn , Buroff Eileen , Ellenberger Janie , Fay Catherine , Konop Marian , Lazar Michael , Mikheyeva Tatiana , Roy Monique , Zarbin Marco , Bhargava Sangeeta , Fine Howard , Fox Gadless Laura , Friedman Eric , Green Stuart , Green Robyn , Keyser Bruce , Leviton Amy , Nelson Celeste , Pilato Jennifer , Prenner Jonathan , Roth Daniel , Schlosser Alex , Shah Sumit , Wheatley H. Matthew , Yarian David , Bansal Alok , Boldrey Edwin , Borrillo Jesus , Chang Louis , Dennis Amy , Depaz Sharon , Gadda Andrea , Goldstein Amy , Khurana Rahul , Lam Diana , Obando Celeste , Palmer James , Sessions Olga , Wieland Mark , Ambrocio Trisha , Casiano Marinel , Chang Eugene , Chen Sanford , Liu Millie , Lowery Jessica , Maggiano John , Rathod Rajiv , You Timothy , Baker Carl , Caldwell Tracey , Camp Alecia , Kettler Samantha , Lambert Lynnette , Martin Tracey , Orr Margaret , Palmer Mary Jill , Tilford Ron , Williams Tana , Bearden Ruth , Clark Lloyd , Darlington Pamela , Griggs Rene , Johnson David , Karuza Stephanie , Miller Peggy , Ogbuewu Tiffany , Payne John , Spivey Robin , Studebaker Ashley , Swinford Tiffany , Taylor Mallie , Watts Deborah , Wells John , Wilson Amanda , Clark W. Lloyd , Floyd Ashley , Garrison Cassandra , Huggins Tyler , Parker Crystal , Poston Erin , Welch Kristin , Williams Ashley , Gaston Janelle , Abdelgani Diana , Blank Colin , Chang Emmanuel , Fredrickson Deborah , Khawly Joseph , Lopez Desiree , Lowd Donald , Martinez Lorena , Miller Pam , Muniz Jason , Pineda Erica , Rahman Hassan , Willis Arthur , Batlle Ivan , Batlle Karla , Bruce Kiersten , Christensen Ryan , Cooper Blake , Dyer David , Fox Gregory , Manning Lexie , Perkins Samantha , Pippin Katherine , Singh Ravi , Suiter Beatty , Yeager Frank , Amonett Brett , Boehm Cindy , Coney Joseph , Coyne Jim , Drugan Tia , DuBois John , Greanoff Gregg , Ilc Mary , Kenska Aimee , McNamara Elizabeth , Miller David , Novak Michael , Rao Llewelyn , Rath Susan , Rykena Cecelia , Schartman Jerome , Singerman Lawrence , Smith Veronica , Tanner Vivian , Buck Michelle , Daniels Vernie , Holcomb Diana , Isernhagen Ricky , Kitchens John , Moshfeghi Andrew , Slade Ed , Stone Thomas , Van Arsdall Jeanne , VanHoose Brenda , Wood William , Burgess Mindy , Connolly Brian , Doran Mary Jo , Guillet Ernest , Hall Edward , Reynard Anne , Rose Steven , Territo Joseph , Whelehan Margaret , Yagoda Meg , Bachmann Dyonne , Brandon Sally , Burdick Kassandra , Carreon Jennifer , Duncan Crystal , Flores Susana , Halper Stacey , Hudson Henry , Kan Amy , Kurup Shree , Mendoza Claudia , Morris Brianna , Novalis George , Wilkins Patricia , Wong Ryan , Worrall Martin , Almanza Belinda , Benz Matthew , Berry Meredith , Brown David , Carranza JoLene , Chen Eric , Dives Brenda , Epp Lauren , Fish Richard , Franks Nikki , Gillaspia Debbie , Hernandez Amy , Kegley Eric , Kim Rosa , Landaverde Nubia , Major James , Quellar Elizabeth , Richter Beau , Royse Tressa , Schefler Amy , Smith Robert , Sneed Veronica , Stoever Cary , Vance Sushma , Wong Tien , Wykoff Charles , Anderson Kelly , Arambula Thomas , Fabro Jennie , Galura Joe , Garcia Nikki , Gomes Leide , Henry Marcy , Hollifield Rodney , Loo Roy , Marchese Janet , Okeke Ifeyinwa , Pezda Matthew , Rendorio Javier , Spencer Treseelyn , Thach Allen , Voo Irene , Wickens Jason , Yepremyan Meher , Anagnoste Scott , Brady-Pyka Jaclyn , del Cid Mario , Dhalla Mandeep , Halperin Lawrence , Hamlin Monica , Lamb Ann Marie , Mannarelli Angelia , Mariano Jamie , O'Koren Linda , Rosenberg Krista , Taney Barry , Thompson W. Scott , Uchiyama Eduardo , Veksler Rita , Casey Heather , Chaudhry Nauman , Cocilo Justin , Fontecchio Alison , German Emma , Charpentier Peggy , Connaughton Michele , Dreyer Richard , Ho Stephanie , Hobbs Stephen , Hoerner Christine , Kopfer Marcia , Lee Michael , Logan Joseph , Ma Colin , Milliron Amanda , Patel Apurva , Peters Mark , Tlucek Paul , Adams Leah , Escamilla Cecilia , Espinoza Geneva , Garcia Kristen , Janzen Grant , Lee Seong , Moreno Priscilla , Patel Sunil , Petty Cindy , Rickert Gary , Villarreal Deisy , Zavaleta Eric , Bergren Robert , Chamberlin Jennifer , Conrad Paul , DiPerna Dawn , Doft Bernard , Eadie James , Fec Amanda , Grossman Moryssa , McBroom Keith , Merlotti Lori , Olsen Karl , Rath Pamela , Schultz Christina , Steinberg David , Stepansky Lois , Vyas Avni , Walter Julie , Bellows Brandi , Brown Jamin , Deforge Teresa , DeSantis Stefanie , Dorr Christine , Gabris Viki , Grinnell Cindy , Hall Christy , Hampton G. Robert , Hay Peter , Kwasniewski Lynn , Manley Michelle , Robarge Nicole , Rosenberg Kevin , Seth Rajeev , Sienkiewycz Laurie , Clark Kim , Foxman Brett , Foxman Scott , Mahan Natalie , Margolis Thomas , Mendez Chastity , Morales Felisha , Morales Suzie x , Rosenthal Julie , Torres Qahdirah , Chang Margaret , Equi Robert , Lopez Danny , Nickerman Erin , Patel Arun , Pearlman Joel , Podesta Nanette , Reed J. Brian , Telander David , Tsai Tony , Waller Brooke , Wendel Robert , Wong Kimberlee , Arenas Sandra , Barakat Mark , Bartoli Dayna , Dugel Pravin , Goldenberg David , Haak L. Milad , Hoback Valerie , Itty Sujit , Jamal Karim , Jimenez Norma , Kunimoto Derek , Levison Ashleigh , Lopez-Wood Georgina , Marcos Elena , Martin John , Mehta Sachin , Palejwala Neal , Quinlan Edward , Ramirez Nohemi , Torres Ignacio , Wilson Diania Joy , Baker Jaynee , Castillo Elaine , Chica Moises , Holy Sarah , Kirschbaum Lita , Lane Richard Gary , Mein Calvin , Moore Tori , Nakoski Brenda , Wienecke C. Sean , Burge Kelli , Cassell Michael , Chen Yin , Elliott Heather , Gallimore Gary , Kietzman Kristen , Kunjukunju Nancy , Niblock Jeanne , Poulose Abraham , Sabates Nelson , Sabates Felix , Snider April , Chen Melvin , Inlow Evelyn , Jelemensky Peggy , Levy Marc , Miller Rosa , Raphael Tara , Sneath Mark , Berger Jim , Brucker Alexander , Caggiano Dominique , Chen Judy , Drossner Sheri , DuPont Joan , Farazdaghi Armin , Kim Benjamin , Morales Sara , Serpentine Beth , VanderBeek Brian , Bailey Thomas , Farooq Amina , Foster Allison , Ivey Ken , Marcus Dennis , Ortiz Siobhan , Singh Harinderjit , Tuey Kim , Woodward Michele , Coppola Patricia , Googe Joseph , Lince Raul , Lovelady Lisa , McMillan Tod , Morris Steve , Oelrich Sarah , Oliver Kristina , Rauen Julie , Shuler R. Keith , Walsh Justin , Whetstone Jerry , Chan Clement , Gonzales Tiana , Huff Kenneth , Lalezary Maziar , Lin Steven , Myers Lenise , Walther Kim , Arrindell Everton , Awh Carl , Bowers Michelle , Briley Amanda , Busbee Brandon , Campbell Talisha , Cooper Narey , Farmer Tara , Ferrell Amanda , Fleischman Casi , Freeman Paul (Dustin) , Hines Sarah , Moffat Kenneth , Morrow Stephanie , Recchia Franco , Reichstein David , Rose Kris , Schneider Eric , Schwebel Natalie , Scott Shari , Smith Gina , Sonkin Peter , Sonnier Cora , Stepney Kyra , Thompson Katlyne , Walker Caleb , Wallace R. Trent , Wiser Susan , Wray Julia , Alva Melissa , Boleman Bob , Callanan David , Creighton Jodi , Curry Michelle , Dock Chris , Lash Sandy , Solley Wayne , Williams Patrick , Anand Rajiv , Arceneaux Sally , Carpintero Daniel , Chong Deborah , Coors Lori , Csaky Karl , Duignan Karen , Fish Gary , Fuller Dwain , Hesse Nick , Jaramillo Diana , Mackens Michael , Marin Samantha , Sanchez Brenda , Stanley Tina , Wang Robert , Bradley Lena , De Stefano Jodi , Figueroa Maria J , Guan Eileen , Hoehn Anne , Irazabal Alexa , Isman Susan , King Jacquie , Kondapaka Radhika , Kumar Hamsa , Lahut Matt , Lindblad Robert , Lovett Robin , Patschak Michael , Rothwell Ro Shauna , Smith Rosemary , Van Dyke Janet , Watson Valerie , Yesko Lauren , Bloom William , Fish PJ , Letson Alan , Mihalik Barbara , Ohr Matthew , Perry Jerilyn , Salerno Jill , Alexander-Snowden Tanya , Alou Sekou , Berinstein Daniel , Blondo Thomas , Camia Jennifer , Chancey Ashley , Clark Clete , Davis Justin , Deegan William , Denny Vanessa , Fanous Irene , Gallerson Bryan , Garfinkel Richard , Gopakumar Smitha , Hanselman Sarah , Iglesias Jessica , Iraheta Yury , Johnson Thomas , Kalisch Molly , King Andrew , Lai Michael , Marin-Quinones Myradis , Melamud Alexander , Murphy Bryan , Murphy Robert , Orencia Stacie , Osman Michael , Phosaksee Jennifer , Rauch Steve , Reilly Gayatri , Renteria Pamela , Rivers Michael , Sanders Reginald , Schorer Nicole , Shah Mona , Shah Manali , Talatory Maya , Tam Tiffany , von Fricken Manfred , Walker Danielle , Blinder Kevin , Boyd Lynda , Guevara Stephanie , Hoehn Erika , Nobel Ginny , Pepple Kelly , Pulliam Brooke , Reardon Diana , Shah Gaurav , Smith Bradley , Stuart Maria , Weeks Rhonda , Wehmeier Jarrod , Wright Tim , Berger Brian , Bravenec Chelsey , Chexal Saradha , Corak Boris , Gunderson Ivana , Hosein Kimberly , Jhaveri Chirag , Manhart Ginger , Nguyen Brandon , Reid Ryan , Ren Yong , Seidu Tina , Stovall Chandler , Ballard Kristi , Blaisdell Ashley , Clay April , Fuentes Shellie , Gillispie Stephanie , Gordon Carmelina , Hill Heather , Litzer Hailey , Lok Elaine , Minier Bonnie , Partridge Susan , Westgate Tiffany , Wireman Jennifer , Wohlscheid Celia , Andrada Marie , Bryant Ashley , Cargill Dominique , Chandra Karishma , Deo Sashi , Imson Katrina , Morse Lawrence , Moshiri Ala , Park Susanna , Redenbo Ellen , Salvador Marisa , Sarwary Nadir , Slabosnitskiy Igor , Trovitch Peter , Turner Jessica , Wallace Cindy , Duncan Jacque , Eubank Don , Fields Scott , Hom Betty , Lew Mary , Light Andrew , Mian Arshia , Stewart Jay , Chalam Kakarla , Cowart Ashley , Grover Sandeep , Gupta Shailesh , Haji Shamim , Hamdani Ghulam , Hart Sherri , Sambhav Kumar , Aprelkov Miroslava , Blackburn Peter , Fraser Claire , Hanson Mike , Higgins Eric , Kleinman Mark , McDonald Deborah , Pearson P. Andrew , Phillips Susan , Pigulko Lyudmila , Reg Michele , Sitzlar Stephen , Smith Lakisha , Musch David C , Wisniewski Stephen , Chung Mina , Czubinski Andrea , DiLoreto David , Forbes Tanya , Gagarinas Gary , Hollar Rachel , Latchney Lisa , Pannell Taylor , Richardson Brittany , Adler Angie , Altaweel Michael , Blodi Barbara , Dietzman Kristine , Gottlieb Justin , Ip Michael , Krolnik Denise , Perry-Raymond Jennie , Peterson John , Reed Sandie , Smith Christopher , Berg Lola , Blaiotta Maria , Do Diana , Greer Lisa , Jawed Fayez , Miller Kristi , Neely Donna , Nguyen Quan , Clifton Brad , Ernst Patricia , Jones Ron , Kinyoun James , Kyle Soojin , Leslie Jim , Pettingill Juli , Purcell Jeffrey , Rath Sue , Rezaei Kasra , Vemulakonda Gurunadh , Vo Bao-Chau , Adyanthaya Rohit , Aguero Lazaro , Anaya Deyla , Cantu Monica , Diaz-Rohena Roberto , Garza Santos , Gonzalez Victor , Jasso Hector , Miranda Karina , Muniz Jessica , Patel Nehal , Rodriguez Rachel , Rodriguez Jessica , Salinas Yesenia , Salinas Nancy , Salinas Kethsaly , Santiago Juan , Villanueva Lissete , Adkins Tony , Agarwal Anita , Brantley Milam , Carlson Joshua , Cherney Edward , Daniels Anthony , Jonna Gowtham , Kim Stephen , Law Janice , Munn Rocky , Owings Sandy , Patel Shriji , Ruark Scott , Skellie Richard , Sternberg Paul , Taylor-Ward Maryann , Anderlini Lea , Bartlett Mark , Combs James , Ebert Eleanore , Hughes Michael , Ladd Byron , McKeever Kristin , Roderick Lynn , Sullivan Karen , Vaughan Melissa , Barloon A. Samuel , Birnbach Charles , Blustein Andrea , Francis Robert , Gagnon Renee , Goldman Pamela , Hunt Ray , Kipp Frances , Klesert Todd , Minnis DeShawn , Nash Robert , Nazarchuk Tetyana , Saperstein David , Wells Craig , Bennett Steven , Bogolin Tamra , Chan-Tram Carmen , Cheshier Holly , Davies John , Dev Sundeep , Enloe Julianne , Gilbert Peggy , Gromov Timothy , Johnson Jill , Jones Tori , Mittra Robert , Oestreich Neal , Parke D. Wilkin , Quiram Polly , Ramsay Robert , Rogers Carol , Royle Joy , Steele Trenise , Tonsfeldt Jessica , Williams David 
Published: May 2023

Importance

Retinal vein occlusion is the second most common retinal vascular disease. Bevacizumab was demonstrated in the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) to be noninferior to aflibercept with respect to visual acuity in study participants with macular edema due to central retinal vein occlusion (CRVO) or hemiretinal vein occlusion (HRVO) following 6 months of therapy. In this study, the cost-utility of bevacizumab vs aflibercept for treatment of CRVO is evaluated.

Objective

To investigate the relative cost-effectiveness of bevacizumab vs aflibercept for treatment of macular edema associated with CRVO or HRVO.

Design, Setting, and Participants

This economic evaluation study used a microsimulation cohort of patients with clinical and demographic characteristics similar to those of SCORE2 participants and a Markov process. Parameters were estimated and validated using a split-sample approach of the SCORE2 population. The simulated cohort included 5000 patients who were evaluated 100 times, each with a different set of characteristics randomly selected based on the SCORE2 trial. SCORE2 data were collected from September 2014 October 2019, and data were analyzed from October 2019 to July 2021.

Interventions

Bevacizumab (followed by aflibercept among patients with a protocol-defined poor or marginal response to bevacizumab at month 6) vs aflibercept (followed by a dexamethasone implant among patients with a protocol-defined poor or marginal response to aflibercept at month 6).

Main Outcomes and Measures

Incremental cost-utility ratio.

Results

The simulation demonstrated that patients treated with aflibercept will have an expected cost $18 127 greater than those treated with bevacizumab in the year following initiation. When coupled with the lack of clinical superiority over bevacizumab (ie, patients treated with bevacizumab had a gain over aflibercept in visual acuity letter score of 4 in the treated eye and 2 in the fellow eye), these results demonstrate that first-line treatment with bevacizumab dominated aflibercept in the simulated cohort of SCORE2 participants. At current price levels, aflibercept would be considered the preferred cost-effective option only if treatment restored the patient to nearly perfect health.

Conclusions and Relevance

While there will be some patients with CRVO-associated or HRVO-associated macular edema who will benefit from first-line treatment with aflibercept rather than bevacizumab, given the minimal differences in visual acuity outcomes and large cost differences for bevacizumab vs aflibercept, first-line treatment with bevacizumab is cost-effective for this condition.