The ERG carried out sensitivity analyses around the relative risk of losing 15 or more letters at 6 months, the administration cost, duration of treatment, adverse events, and the source of utility values. The ERG used the discount to the list price of aflibercept and reduced the list price of ranibizumab by a value of either 0% or 10 to 50% in increments of 5%.
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When the relative risk of losing letters was included in the model and a discount of 0 to 45% was applied to the list price of ranibizumab, aflibercept dominated ranibizumab (incremental costs ranged from −£3,005 to −£78, incremental QALYs 0.003). When a 50% discount was applied to the list price of ranibizumab, the ICER for aflibercept compared with ranibizumab was £86,789 per QALY gained (incremental cost £247, incremental QALY 0.003).
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When the administration cost was reduced in the model and a discount of 0 to 45% was applied to the list price of ranibizumab, aflibercept dominated ranibizumab (incremental costs ranged from −£3,083 to −£156, incremental QALYs 0.053). When a 50% discount was applied to the list price of ranibizumab, the ICER for aflibercept compared with ranibizumab was £3,176 per QALY gained (incremental cost £169, incremental QALY 0.053).
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When the duration of treatment was extended to 2 years and a discount of 0 to 45% was applied to the list price of ranibizumab, aflibercept dominated ranibizumab (incremental costs ranged from −£4,422 to −£285, incremental QALYs 0.053). When a 50% discount was applied to the list price of ranibizumab, the ICER for aflibercept compared with ranibizumab was £3,274 per QALY gained (incremental cost £175, incremental QALY 0.053).
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When the duration of treatment was extended to 5 years and a discount of 0 to 50% was applied to the list price of ranibizumab, aflibercept dominated ranibizumab (incremental costs ranged from −£6,838 to −£31, incremental QALYs 0.053).
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When costs of adverse events were included in the model and a discount of 0 to 45% was applied to the list price of ranibizumab, aflibercept dominated ranibizumab (incremental costs ranged from −£3,066 to −£139, incremental QALYs 0.053). When a 50% discount was applied to the list price of ranibizumab, the ICER for aflibercept compared with ranibizumab was £3,489 per QALY gained (incremental cost £187, incremental QALY 0.053).
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When Czoski-Murray utility values with the 'worse-seeing eye' were used in the model and a discount of 0 to 45% was applied to the list price of ranibizumab, aflibercept dominated ranibizumab (incremental costs ranged from −£3,049 to −£122, incremental QALYs 0.053). When a 50% discount was applied to the list price of ranibizumab the ICER for aflibercept compared with ranibizumab was £3,851 per QALY gained (incremental cost £203, incremental QALY 0.053).
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When Brown utility values with the 'worse-seeing eye' were used in the model and a discount of 0 to 45% was applied to the list price of ranibizumab, aflibercept dominated ranibizumab (incremental costs ranged from −£3,049 to −£122, incremental QALYs 0.040). When a 50% discount was applied to the list price of ranibizumab, the ICER for aflibercept compared with ranibizumab was £5,076 per QALY gained (incremental cost £203, incremental QALY 0.040).