Abstract
Purpose :
To compare the frequency and costs of intravitreal anti-VEGF injections, in treatment-naïve (TN) or previously-treated (PT) patients with DME receiving ranibizumab (RBZ) 0.3 mg vs aflibercept (AFL) 2.0 mg.
Methods :
This retrospective study of US Medicare claims data included patients who initiated treatment with RBZ or AFL (index date [ID] August 10, 2012 to July 31, 2015) with the following criteria: aged ≥18 years on ID; 12 months’ continuous eligibility before ID and for 3–12 months following ID without switching to a different anti-VEGF agent. Number of injections and related costs were determined at 3-, 6-, 9-, and 12-month follow-up. Injection frequency and costs for RBZ vs AFL were compared by multivariate regression models. All models were adjusted for patient demographics and clinical characteristics.
Results :
In both TN (baseline [BL]: RBZ [N=1,305]; AFL [N=409]) and PT (BL: RBZ [N=756]; AFL [N=575]) patients, there were no statistically significant differences between treatment groups in the frequency of injections at months 3, 6, 9, and 12. However, statistically significant differences in cost, in favor of RBZ, were seen across all time points in both TN and PT patients. For example, in TN patients at 6-months’ follow-up, adjusted injection costs were $3,466 vs $5,979 for RBZ (N=912) and AFL (N=138), respectively; the adjusted cost ratio was 1.73 (95% CI=1.53–1.94), p<0.0001. The adjusted cost ratio was also significantly in favor of RBZ at months 3 and 9 (p<0.0001) and month 12 (p=0.04). Similarly, in PT patients at 6 months, the adjusted injection costs were $3,660 vs $5,759 for RBZ (N=465) and AFL (N=165), respectively; the adjusted cost ratio was 1.57 (95% CI=1.35–1.84), p<0.0001. The adjusted cost ratio was also significantly in favor of RBZ at month 3 (p<0.0001), month 9 (p=0.009) and month 12 (p=0.018).
Conclusions :
For each analyzed follow-up period, and for both TN and PT patients, injection frequency did not differ significantly between RBZ and AFL treatments. Importantly, substantial and statistically significant differences (all p<0.05) in the costs of anti-VEGF injections were observed between RBZ and AFL treatments. While the data should be interpreted with caution (decreasing sample size; need for continued study) RBZ was the less costly treatment for DME regardless of follow-up time.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.