Ranibizumab vs. laser photocoagulation for treating retinopathy in premature infants: a three-year cost-effectiveness analysis

Background The standard treatments for retinopathy of prematurity (ROP) include laser photocoagulation of the avascular retina and intravitreal injections of anti-vascular endothelial growth factor agents. While laser photocoagulation is effective, it may lead to poor visual development. Conversely, the anti-vascular endothelial growth factor antibody, ranibizumab, is associated with a high recurrence rate. It is therefore important to consider the cost-effectiveness of these treatments. This study evaluated the three-year cost-effectiveness of ranibizumab vs. laser photocoagulation for ROP treatment. Methods This study performed cost-effectiveness analysis using a decision tree and Markov model, from both societal and public healthcare perspectives. Ranibizumab or laser photocoagulation was initially administered, and either treatment was added if ROP recurred. The incremental cost-effectiveness ratio (ICER) was calculated from a public healthcare perspective. One-way and probabilistic sensitivity analyses were conducted. Results Comparing ranibizumab with laser photocoagulation, ICER was approximately 67,000 yen over the three-year analysis period. This is below the upper limit of the willingness-to-pay threshold in Japan of 7.5 million yen and is considered highly cost-effective. Conclusion Intravitreal ranibizumab for ROP has a better visual prognosis than retinal photocoagulation. It is more cost-effective and considered useful for selecting a treatment method, even if it increases the number of outpatient visits and requires additional treatment.