The Biosimilar Paradox: How Anti-VEGF Biosimilars will Increase Patient and Overall Healthcare Costs

Abstract

Purpose : Anti-vascular endothelial growth factor (anti-VEGF) medications have a major and increasing cost on healthcare and patients. Biosimilar use may be a means to reducing these costs. However, the impending approval of an ophthalmic biosimilar formulation of bevacizumab, bevacizumab-vikg, may paradoxically increase the cost burden of intravitreal anti-VEGF, as “off-label” compounded drug may no longer be an option. We aim to investigate the impact of biosimilars on health system and patient costs in the US.

Methods : All data presented is current publicly available Medicare data and previously published market share data. Average sales price (ASP) of ranibizumab, aflibercept, and bevacizumab are calculated from Medicare allowable payments and a previously published representative Medicare administrative contractor allowable. ASPs of biosimilars are calculated from wholesale acquisition costs from a representative distributor. The cost of an intraocular bevacizumab formulation is modeled at $500 and $900 per injection, increased from $84.91 per injection with current off-label use.

Results : If an intraocular bevacizumab were to be priced at $500, costs to Medicare would increase by $457 million from $3.01 billion to $3.47 billion (an increase of 15.2%). Patient responsibility would increase by $117 million from $768 million to $884 million. Similarly, if intraocular bevacizumab were priced at $900, Medicare costs would increase by $897 million to $3.91 billion (an increase of 29.8%), and patient responsibility would increase by $229 million to $997 million. Theoretically, use of ranibizumab and aflibercept biosimilars may offset the increased cost of bevacizumab, reducing the overall costs. However, were the price of bevacizumab to increase to $500, switching all patients currently on ranibizumab or aflibercept to respective biosimilars would only compensate for 28.1% of the increased cost.

Conclusions : The eyecare sector faces a potential drastic increase in costs following the approval of an intraocular bevacizumab biosimilar and must find a way to keep intravitreal anti-VEGF injections accessible.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Pricing an intraocular bevacizumab biosimilar at $500 per injection would result in a 15.2% increase in Medicare costs. Switching all patients currently on ranibizumab or aflibercept to respective biosimilars would only compensate for 28.1% of this increased cost.