Comparative effectiveness research (CER) has received widespread attention and federal funding because of its potential to inform and improve treatment decisions. Since 2005, patients and their ophthalmologists have faced a dilemma in treating age-related macular degeneration (AMD)—the leading cause of blindness in the United States. Two closely related drugs have produced dramatic improvements in vision; one has been rigorously tested for use in AMD patients, while the other has been rigorously tested for use in cancer patients, but is now widely used to treat AMD. One drug costs 40 times as much as the other. This Issue Brief summarizes a CER study comparing these drugs head-to-head, and provides the most definitive evidence to date about the safety and effectiveness of the two alternatives

Maguire, Maureen G

English

Kosmopolis

University of Pennsylvania
ScholarlyCommons
Issue Briefs Leonard Davis Institute of Health Economics
6-13-2012
Comparing Treatments for Age-related Macular
Degeneration: Safety, Effectiveness and Cost
Maureen G. Maguire
Follow this and additional works at: http://repository.upenn.edu/ldi_issuebriefs
Part of the Health Services Research Commons
This paper is posted at ScholarlyCommons. http://repository.upenn.edu/ldi_issuebriefs/102
For more information, please contact repository@pobox.upenn.edu.
Maguire, Maureen G.. Comparing Treatments for Age-related Macular Degeneration: Safety, Effectiveness and Cost. LDI Issue Briefs.
2012; 17 (8). http://ldi.upenn.edu/policy/issue-briefs/2012/06/13/comparing-treatments-for-age-related-macular-degeneration-
safety-effectiveness-and-cost
Comparing Treatments for Age-related Macular Degeneration: Safety,
Effectiveness and Cost
Abstract
Comparative effectiveness research (CER) has received widespread attention and federal funding because of
its potential to inform and improve treatment decisions. Since 2005, patients and their ophthalmologists have
faced a dilemma in treating age-related macular degeneration (AMD)—the leading cause of blindness in the
United States. Two closely related drugs have produced dramatic improvements in vision; one has been
rigorously tested for use in AMD patients, while the other has been rigorously tested for use in cancer patients,
but is now widely used to treat AMD. One drug costs 40 times as much as the other. This Issue Brief
summarizes a CER study comparing these drugs head-to-head, and provides the most definitive evidence to
date about the safety and effectiveness of the two alternatives.
Keywords
evidence development & decision science, comparative effectiveness research/PCORI
Disciplines
Health Services Research
License
This work is licensed under a Creative Commons Attribution-No Derivative Works 4.0 License.
This brief is available at ScholarlyCommons: http://repository.upenn.edu/ldi_issuebriefs/102
Leonard Davis Institute of Health Economics Volume 17, Issue 8• June 2012
Maureen G. Maguire, PhD
LDI Senior Fellow, 
Carolyn F. Jones 
Professor of Ophthalmology 
University of Pennsylvania
Comparing Treatments for Age-Related 
Macular Degeneration: Safety, 
Effectiveness and Cost
Editor’s note: Comparative effectiveness research (CER) has received widespread 
attention and federal funding because of its potential to inform and improve 
treatment decisions. Since 2005, patients and their ophthalmologists have faced 
a dilemma in treating age-related macular degeneration (AMD)—the leading 
cause of blindness in the United States. Two closely related drugs have produced 
dramatic improvements in vision; one has been rigorously tested for use in AMD 
patients, while the other has been rigorously tested for use in cancer patients, but 
is now widely used to treat AMD. One drug costs 40 times as much as the other. 
This Issue Brief summarizes a CER study comparing these drugs head-to-head, 
and provides the most definitive evidence to date about the safety and effectiveness 
of the two alternatives.
About 200,000 cases of severe (so-called “wet”) AMD are diagnosed each year in 
the U.S., primarily in people 60 and older. Before 2005, most of these patients 
faced a progressive loss of central vision and legal blindness. But in 2005, clinical 
trials showed that monthly intraocular injections of a new drug, ranibizumab 
(Lucentis, Genentech) could slow the rate of vision loss and improve visual acuity 
for people with wet AMD. Lucentis works by inhibiting abnormal growth and 
leakage of blood vessels behind the retina.
•	 While	awaiting	approval	for	Lucentis	from	the	Food	and	Drug	Administration	
(FDA),	ophthalmologists	began	using	bevacizumab	(Avastin,	Genentech),	a	
closely related drug already on the market. Avastin had been approved by the 
FDA	as	an	intravenous	cancer	therapy	in	2004.	Lucentis	and	Avastin	share	anti-
vascular growth properties.
•	 This	off-label	use	of	Avastin	spread	widely,	despite	the	absence	of	high	quality	
data	supporting	its	use.	Avastin	quickly	became	the	most	commonly	used	
drug	for	treating	wet	AMD.	Even	after	the	FDA	approved	Lucentis	in	2006,	
ophthalmologists continued to use Avastin. The reason was primarily financial: 
a single dose of Lucentis costs about $2,000 compared to a single dose of 
Avastin, which costs about $50 after being repackaged from the much larger 
intravenous dosages used in cancer treatment. Ophthalmologists also adopted 
an as-needed regimen for both drugs, a departure from the monthly regimen of 
Lucentis tested in clinical trials.
Age-related macular 
degeneration (AMD) 
treatment breakthrough leads 
to clinical dilemma
The	CATT	study	was	designed	to	answer	two	questions	about	AMD	treatment:	
Is Avastin as safe and effective as Lucentis? Does “as needed” dosing of either 
drug compromise long-term visual outcomes, compared to fixed monthly dosing? 
Patients were randomly assigned to one of four groups: monthly Avastin, monthly 
Lucentis, as-needed Avastin, and as-needed Lucentis. In the as-needed groups, 
after the first mandatory injection, injections were given when an ophthalmologist 
saw signs of active disease, such as fluid leakage, at a monthly evaluation. 
•	 The	investigators	assessed	changes	in	visual	acuity	after	one	year,	as	measured 
by letters on a standardized eye chart. They also measured anatomic changes in 
the retina (thickness and fluid), serious adverse events, and total drug costs in 
each group.
•	 After	one	year,	the	patients	assigned	to	monthly	treatments	were	reassigned	
randomly, to continue with monthly treatments or switch to as-needed 
treatment. This design enabled the investigators to assess the longer-term 
outcomes of the original treatment groups and to understand the impact of 
switching from monthly to as-needed treatment.
•	 From	February	2008	to	December	2009,	the	CATT	study	enrolled	1,208	
patients at 44 clinical centers in the U.S. The patients were at least 50 years old, 
had previously untreated wet AMD, and visual acuity between 20/25 
and 20/320. 
Randomized clinical trial 
compares Avastin and 
Lucentis, and tests different 
dosing schedules
A	total	of	1,105	patients	completed	the	one-year	follow	up.	Almost	all	patients	
were	over	60,	with	a	median	age	of	over	80.	At	one	year,	Avastin	and	Lucentis	had	
equivalent	effects	on	visual	acuity	when	administered	according	to	the 
same schedule.
•	 On	average,	patients	gained	6-7	letters	on	the	eye	chart	in	all	four	study	groups.	
Most of the improvement occurred during the first six months. Monthly 
injections of Avastin and Lucentis produced the same visual improvement. 
Lucentis	given	as	needed	was	equivalent	to	Avastin	given	as	needed	and	
Lucentis given monthly. The comparison of monthly Avastin with as-needed 
Avastin was inconclusive.
•	 Both	drugs	resulted	in	substantial	reductions	in	central	retinal	thickness,	but	
monthly Lucentis produced a greater decrease than the other groups. Although 
these differences in anatomy had no impact on vision at one year, the long-term 
implications are not known.
•	 No	significant	differences	in	ophthalmic	adverse	events	were	noted	between	the	
two drugs. The study detected no differences in relatively rare events such as 
death, heart attacks, and stroke, which had been a concern when Avastin was 
used intravenously for cancer treatment. 
At one year, Avastin and 
Lucentis led to similar 
improvements in vision
•	 The	manufacturer	of	both	drugs,	Genentech,	actively	discouraged	the	use	
of Avastin for AMD, saying that Lucentis had been developed and tested 
specifically for intraocular use, and warning that the safety and efficacy of 
repackaged Avastin was unknown. The need for a head-to-head trial comparing 
Avastin	and	Lucentis	became	obvious.	In	2006,	the	National	Eye	Institute	
funded the Comparison of AMD Treatments Trials (CATT).
At two years, both Avastin and 
Lucentis produced dramatic 
improvements in vision
At two years, the CATT study confirmed that Avastin and Lucentis had similar 
and substantial effects on visual acuity when the dosing regimen was the same. 
At two years, two-thirds of patients had driving vision (20/40 vision or better). 
•	 Most	of	the	change	in	visual	acuity	occurred	during	the	first	year,	with	very	
little change during the second. The anatomic differences observed in the first 
year persisted in the second year. 
•	 As-needed	dosing	resulted	in	10	fewer	eye	injections	over	the	two-year	period	
than monthly dosing. However, as-needed dosing of either drug produced 
slightly less gain in visual acuity, whether instituted at enrollment or after one 
year of monthly treatment. This slight difference amounted to an average of 2.4 
letters (half a line) gained on the eye chart.
•	 The	number	of	eye	complications,	deaths,	strokes	and	heart	attacks	were	
similar for all groups. The rates of serious adverse events remained higher in the 
combined Avastin groups (40%) than the Lucentis groups (32%). The greatest 
difference was in gastrointestinal disorders, which has been an area of concern 
in previous studies of intravenous Avastin. But even when all events known to 
be associated with Avastin were excluded, most of the imbalance remained.
•	 The	two-year	drug	cost	per	patient	ranged	from	$705	in	the	Avastin	as-needed	
group,	$1,170	in	the	monthly	Avastin	group,	$25,200	in	the	Lucentis	as-
needed	group	and	$44,800	in	monthly	Lucentis	group.	
Continued on back.
POLICY IMPLICATIONS These results confirm the dramatic and lasting improvement in vision that both 
Avastin and Lucentis provide for AMD patients. In that context, this comparative 
effectiveness study provides patients and clinicians with evidence upon which to 
base their treatment decisions. 
•	 In	2010,	Lucentis	accounted	for	nearly	10%	of	the	entire	Medicare	Part	B	drug	
budget,	its	single	largest	expenditure	at	$1.1	billion.	Medicare	beneficiaries	face	
a	$400	copayment	for	each	dose	of	Lucentis,	compared	to	an	$11	copayment	
for Avastin. As treatment for AMD continues indefinitely, the financial impact 
will also continue. The choice of drug and dosing regimen must balance the 
comparable effects on vision, the possibility of true differences in adverse events, 
and the 40-fold difference in cost per dose between Avastin and Lucentis.
•	 Patients	and	clinicians	now	have	better	data	upon	which	to	base	decisions	about	
dosing regimens. Patients can weigh the risks and benefits of monthly versus 
as-needed	treatments,	and	decide	whether	the	small	gain	in	vision	is	worth	10	
extra injections over two years. 
•	 However,	when	the	dosing-regimen	groups	were	combined,	patients	in	
the Avastin groups had higher rates of adverse events (24%), primarily 
hospitalizations,	than	the	Lucentis	groups	(19%).	The	hospitalizations	were	
not for conditions identified with Avastin in cancer trials involving patients 
who received intravenous doses 500 times those used in intraocular injections. 
Further,	the	as-needed	groups,	which	had	fewer	doses	of	the	drug,	had	higher	
rates of adverse events than the monthly groups.
•	 The	as-needed	groups	averaged	6.9	injections	of	Lucentis	and	7.7	injections	of	
Avastin.	The	average	drug	cost	per	patient	was	$385	for	the	Avastin	as-needed	
group,	$595	for	the	Avastin	monthly	group,	$13,800	for	the	Lucentis	as-needed	
group, and $23,400 in the Lucentis monthly group.
Nonprofit Organization
U.S. Postage
P  A  I  D
Permit No. 2563
Philadelphia, PA 19104
Issue Brief
Published by the
Leonard Davis Institute
of Health Economics
University of Pennsylvania
3641 Locust Walk
Philadelphia, PA 19104-6218
215.898.5611
fax 215.898.0229
ADDRESS CORRECTION REQUESTED
POLICY IMPLICATIONS
Continued
This Issue Brief is based on the following articles: Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) Research Group Writing Committee: D.F. 
Martin, M.G. Maguire, S.L. Fine, et al. Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results. Ophthalmology, 
in press, available online May 1, 2012,  http://dx.doi.org/10.1016/j.ophtha.2012.03.053; CATT Research Group Writing Committee: D.F. Martin, M.G. Maguire, et 
al. Ranibizumab and bevacizumab for neovascular age-related macular degeneration. New England Journal of Medicine, May 19, 2011, vol. 364, pp. 1897-1908; D. 
F. Martin, M.G. Maguire, S.L. Fine. Identifying and eliminating roadblocks to comparative-effectiveness research. New England Journal of Medicine, July 8, 2010, vol. 
363, pp. 105-107.
Published by the Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104. 
Janet Weiner, MPH, Associate Director for Health Policy, Editor  
David A. Asch, MD, MBA, Executive Director
Issue Briefs synthesize the results of research by LDI’s Senior Fellows, a consortium of Penn scholars studying medical, economic, and social and ethical issues 
that influence how health care is organized, financed, managed, and delivered in the United States and internationally. The LDI is a cooperative venture 
among Penn schools including Medicine, Nursing, Dental Medicine, Communication, Law, and Wharton, and the Children’s Hospital of Philadelphia. 
For additional information on this or other Issue Briefs, contact Janet Weiner (e-mail: weinerja@mail.med.upenn.edu; 215-573-9374).
©	2012	Leonard	Davis	Institute
Visit us on the web at http://ldi.upenn.edu
•	 The	higher	rate	of	adverse	events	in	Avastin	groups,	without	a	typical	dose-
response relationship and in organ systems not targeted by the drug, remains 
unexplained. It may be that the difference was the result of chance, unobserved 
differences in the groups at baseline, or truly higher risk. Results from ongoing 
trials worldwide may provide additional insight into the risk of Avastin relative 
to Lucentis.
•	 This	study	exemplifies	how	CER	can	identify	clinical	inefficiencies	and	promote	
cost-effective	care.	Further,	it	highlights	the	importance	of	public	funding	of	
such studies in cases when a drug manufacturer has an economic disincentive to 
investigate the use of an existing drug for new purposes.


Comparing Treatments for Age-related Macular Degeneration: Safety, Effectiveness and Cost

ScholarlyCommons@Penn

University of PennsylvaniaScholarlyCommonsIssue Briefs Leonard Davis Institute of Health Economics6-13-2012Comparing Treatments for Age-related MacularDegeneration: Safety, Effectiveness and CostMaureen G. MaguireFollow this and additional works at: http://repository.upenn.edu/ldi_issuebriefsPart of the Health Services Research CommonsThis paper is posted at ScholarlyCommons. http://repository.upenn.edu/ldi_issuebriefs/102For more information, please contact repository@pobox.upenn.edu.Maguire, Maureen G.. Comparing Treatments for Age-related Macular Degeneration: Safety, Effectiveness and Cost. LDI Issue Briefs.2012; 17 (8). http://ldi.upenn.edu/policy/issue-briefs/2012/06/13/comparing-treatments-for-age-related-macular-degeneration-safety-effectiveness-and-costComparing Treatments for Age-related Macular Degeneration: Safety,Effectiveness and CostAbstractComparative effectiveness research (CER) has received widespread attention and federal funding because ofits potential to inform and improve treatment decisions. Since 2005, patients and their ophthalmologists havefaced a dilemma in treating age-related macular degeneration (AMD)—the leading cause of blindness in theUnited States. Two closely related drugs have produced dramatic improvements in vision; one has beenrigorously tested for use in AMD patients, while the other has been rigorously tested for use in cancer patients,but is now widely used to treat AMD. One drug costs 40 times as much as the other. This Issue Briefsummarizes a CER study comparing these drugs head-to-head, and provides the most definitive evidence todate about the safety and effectiveness of the two alternatives.Keywordsevidence development & decision science, comparative effectiveness research/PCORIDisciplinesHealth Services ResearchLicenseThis work is licensed under a Creative Commons Attribution-No Derivative Works 4.0 License.This brief is available at ScholarlyCommons: http://repository.upenn.edu/ldi_issuebriefs/102Leonard Davis Institute of Health Economics Volume 17, Issue 8• June 2012Maureen G. Maguire, PhDLDI Senior Fellow, Carolyn F. Jones Professor of Ophthalmology University of PennsylvaniaComparing Treatments for Age-Related Macular Degeneration: Safety, Effectiveness and CostEditor’s note: Comparative effectiveness research (CER) has received widespread attention and federal funding because of its potential to inform and improve treatment decisions. Since 2005, patients and their ophthalmologists have faced a dilemma in treating age-related macular degeneration (AMD)—the leading cause of blindness in the United States. Two closely related drugs have produced dramatic improvements in vision; one has been rigorously tested for use in AMD patients, while the other has been rigorously tested for use in cancer patients, but is now widely used to treat AMD. One drug costs 40 times as much as the other. This Issue Brief summarizes a CER study comparing these drugs head-to-head, and provides the most definitive evidence to date about the safety and effectiveness of the two alternatives.About 200,000 cases of severe (so-called “wet”) AMD are diagnosed each year in the U.S., primarily in people 60 and older. Before 2005, most of these patients faced a progressive loss of central vision and legal blindness. But in 2005, clinical trials showed that monthly intraocular injections of a new drug, ranibizumab (Lucentis, Genentech) could slow the rate of vision loss and improve visual acuity for people with wet AMD. Lucentis works by inhibiting abnormal growth and leakage of blood vessels behind the retina.•	 While	awaiting	approval	for	Lucentis	from	the	Food	and	Drug	Administration	(FDA),	ophthalmologists	began	using	bevacizumab	(Avastin,	Genentech),	a	closely related drug already on the market. Avastin had been approved by the FDA	as	an	intravenous	cancer	therapy	in	2004.	Lucentis	and	Avastin	share	anti-vascular growth properties.•	 This	off-label	use	of	Avastin	spread	widely,	despite	the	absence	of	high	quality	data	supporting	its	use.	Avastin	quickly	became	the	most	commonly	used	drug	for	treating	wet	AMD.	Even	after	the	FDA	approved	Lucentis	in	2006,	ophthalmologists continued to use Avastin. The reason was primarily financial: a single dose of Lucentis costs about $2,000 compared to a single dose of Avastin, which costs about $50 after being repackaged from the much larger intravenous dosages used in cancer treatment. Ophthalmologists also adopted an as-needed regimen for both drugs, a departure from the monthly regimen of Lucentis tested in clinical trials.Age-related macular degeneration (AMD) treatment breakthrough leads to clinical dilemmaThe	CATT	study	was	designed	to	answer	two	questions	about	AMD	treatment:	Is Avastin as safe and effective as Lucentis? Does “as needed” dosing of either drug compromise long-term visual outcomes, compared to fixed monthly dosing? Patients were randomly assigned to one of four groups: monthly Avastin, monthly Lucentis, as-needed Avastin, and as-needed Lucentis. In the as-needed groups, after the first mandatory injection, injections were given when an ophthalmologist saw signs of active disease, such as fluid leakage, at a monthly evaluation. •	 The	investigators	assessed	changes	in	visual	acuity	after	one	year,	as	measured by letters on a standardized eye chart. They also measured anatomic changes in the retina (thickness and fluid), serious adverse events, and total drug costs in each group.•	 After	one	year,	the	patients	assigned	to	monthly	treatments	were	reassigned	randomly, to continue with monthly treatments or switch to as-needed treatment. This design enabled the investigators to assess the longer-term outcomes of the original treatment groups and to understand the impact of switching from monthly to as-needed treatment.•	 From	February	2008	to	December	2009,	the	CATT	study	enrolled	1,208	patients at 44 clinical centers in the U.S. The patients were at least 50 years old, had previously untreated wet AMD, and visual acuity between 20/25 and 20/320. Randomized clinical trial compares Avastin and Lucentis, and tests different dosing schedulesA	total	of	1,105	patients	completed	the	one-year	follow	up.	Almost	all	patients	were	over	60,	with	a	median	age	of	over	80.	At	one	year,	Avastin	and	Lucentis	had	equivalent	effects	on	visual	acuity	when	administered	according	to	the same schedule.•	 On	average,	patients	gained	6-7	letters	on	the	eye	chart	in	all	four	study	groups.	Most of the improvement occurred during the first six months. Monthly injections of Avastin and Lucentis produced the same visual improvement. Lucentis	given	as	needed	was	equivalent	to	Avastin	given	as	needed	and	Lucentis given monthly. The comparison of monthly Avastin with as-needed Avastin was inconclusive.•	 Both	drugs	resulted	in	substantial	reductions	in	central	retinal	thickness,	but	monthly Lucentis produced a greater decrease than the other groups. Although these differences in anatomy had no impact on vision at one year, the long-term implications are not known.•	 No	significant	differences	in	ophthalmic	adverse	events	were	noted	between	the	two drugs. The study detected no differences in relatively rare events such as death, heart attacks, and stroke, which had been a concern when Avastin was used intravenously for cancer treatment. At one year, Avastin and Lucentis led to similar improvements in vision•	 The	manufacturer	of	both	drugs,	Genentech,	actively	discouraged	the	use	of Avastin for AMD, saying that Lucentis had been developed and tested specifically for intraocular use, and warning that the safety and efficacy of repackaged Avastin was unknown. The need for a head-to-head trial comparing Avastin	and	Lucentis	became	obvious.	In	2006,	the	National	Eye	Institute	funded the Comparison of AMD Treatments Trials (CATT).At two years, both Avastin and Lucentis produced dramatic improvements in visionAt two years, the CATT study confirmed that Avastin and Lucentis had similar and substantial effects on visual acuity when the dosing regimen was the same. At two years, two-thirds of patients had driving vision (20/40 vision or better). •	 Most	of	the	change	in	visual	acuity	occurred	during	the	first	year,	with	very	little change during the second. The anatomic differences observed in the first year persisted in the second year. •	 As-needed	dosing	resulted	in	10	fewer	eye	injections	over	the	two-year	period	than monthly dosing. However, as-needed dosing of either drug produced slightly less gain in visual acuity, whether instituted at enrollment or after one year of monthly treatment. This slight difference amounted to an average of 2.4 letters (half a line) gained on the eye chart.•	 The	number	of	eye	complications,	deaths,	strokes	and	heart	attacks	were	similar for all groups. The rates of serious adverse events remained higher in the combined Avastin groups (40%) than the Lucentis groups (32%). The greatest difference was in gastrointestinal disorders, which has been an area of concern in previous studies of intravenous Avastin. But even when all events known to be associated with Avastin were excluded, most of the imbalance remained.•	 The	two-year	drug	cost	per	patient	ranged	from	$705	in	the	Avastin	as-needed	group,	$1,170	in	the	monthly	Avastin	group,	$25,200	in	the	Lucentis	as-needed	group	and	$44,800	in	monthly	Lucentis	group.	Continued on back.POLICY IMPLICATIONS These results confirm the dramatic and lasting improvement in vision that both Avastin and Lucentis provide for AMD patients. In that context, this comparative effectiveness study provides patients and clinicians with evidence upon which to base their treatment decisions. •	 In	2010,	Lucentis	accounted	for	nearly	10%	of	the	entire	Medicare	Part	B	drug	budget,	its	single	largest	expenditure	at	$1.1	billion.	Medicare	beneficiaries	face	a	$400	copayment	for	each	dose	of	Lucentis,	compared	to	an	$11	copayment	for Avastin. As treatment for AMD continues indefinitely, the financial impact will also continue. The choice of drug and dosing regimen must balance the comparable effects on vision, the possibility of true differences in adverse events, and the 40-fold difference in cost per dose between Avastin and Lucentis.•	 Patients	and	clinicians	now	have	better	data	upon	which	to	base	decisions	about	dosing regimens. Patients can weigh the risks and benefits of monthly versus as-needed	treatments,	and	decide	whether	the	small	gain	in	vision	is	worth	10	extra injections over two years. •	 However,	when	the	dosing-regimen	groups	were	combined,	patients	in	the Avastin groups had higher rates of adverse events (24%), primarily hospitalizations,	than	the	Lucentis	groups	(19%).	The	hospitalizations	were	not for conditions identified with Avastin in cancer trials involving patients who received intravenous doses 500 times those used in intraocular injections. Further,	the	as-needed	groups,	which	had	fewer	doses	of	the	drug,	had	higher	rates of adverse events than the monthly groups.•	 The	as-needed	groups	averaged	6.9	injections	of	Lucentis	and	7.7	injections	of	Avastin.	The	average	drug	cost	per	patient	was	$385	for	the	Avastin	as-needed	group,	$595	for	the	Avastin	monthly	group,	$13,800	for	the	Lucentis	as-needed	group, and $23,400 in the Lucentis monthly group.Nonprofit OrganizationU.S. PostageP  A  I  DPermit No. 2563Philadelphia, PA 19104Issue BriefPublished by theLeonard Davis Instituteof Health EconomicsUniversity of Pennsylvania3641 Locust WalkPhiladelphia, PA 19104-6218215.898.5611fax 215.898.0229ADDRESS CORRECTION REQUESTEDPOLICY IMPLICATIONSContinuedThis Issue Brief is based on the following articles: Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) Research Group Writing Committee: D.F. Martin, M.G. Maguire, S.L. Fine, et al. Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results. Ophthalmology, in press, available online May 1, 2012,  http://dx.doi.org/10.1016/j.ophtha.2012.03.053; CATT Research Group Writing Committee: D.F. Martin, M.G. Maguire, et al. Ranibizumab and bevacizumab for neovascular age-related macular degeneration. New England Journal of Medicine, May 19, 2011, vol. 364, pp. 1897-1908; D. F. Martin, M.G. Maguire, S.L. Fine. Identifying and eliminating roadblocks to comparative-effectiveness research. New England Journal of Medicine, July 8, 2010, vol. 363, pp. 105-107.Published by the Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104. Janet Weiner, MPH, Associate Director for Health Policy, Editor  David A. Asch, MD, MBA, Executive DirectorIssue Briefs synthesize the results of research by LDI’s Senior Fellows, a consortium of Penn scholars studying medical, economic, and social and ethical issues that influence how health care is organized, financed, managed, and delivered in the United States and internationally. The LDI is a cooperative venture among Penn schools including Medicine, Nursing, Dental Medicine, Communication, Law, and Wharton, and the Children’s Hospital of Philadelphia. For additional information on this or other Issue Briefs, contact Janet Weiner (e-mail: weinerja@mail.med.upenn.edu; 215-573-9374).©	2012	Leonard	Davis	InstituteVisit us on the web at http://ldi.upenn.edu•	 The	higher	rate	of	adverse	events	in	Avastin	groups,	without	a	typical	dose-response relationship and in organ systems not targeted by the drug, remains unexplained. It may be that the difference was the result of chance, unobserved differences in the groups at baseline, or truly higher risk. Results from ongoing trials worldwide may provide additional insight into the risk of Avastin relative to Lucentis.•	 This	study	exemplifies	how	CER	can	identify	clinical	inefficiencies	and	promote	cost-effective	care.	Further,	it	highlights	the	importance	of	public	funding	of	such studies in cases when a drug manufacturer has an economic disincentive to investigate the use of an existing drug for new purposes.

https://repository.upenn.edu/cgi/viewcontent.cgi?article=1012&amp;context=ldi_issuebriefs

Comparing Treatments for Age-related Macular Degeneration: Safety, Effectiveness and Cost

Abstract

Similar works

Full text

Available Versions

Kosmopolis

ScholarlyCommons@Penn