Abstract
Purpose :
Newer extended-dosing anti-VEGF therapies such as aflibercept 8 mg and faricimab 6 mg approved for neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) may provide relief from frequent clinic visits for patients. However, the implications for health care spending remain unclear. We investigate the total costs of treating nAMD and DME with faricimab and aflibercept 8 mg compared to bevacizumab and aflibercept 2 mg.
Methods :
We calculated the 1- and 2-year costs of different treatment regimens of faricimab and aflibercept 8 mg to determine the break-even number of bevacizumab and aflibercept 2 mg injections. We compiled data on treatment dosing intervals from non-inferiority trials for faricimab and aflibercept 8 mg under both the nAMD and DME indication to use as inputs in our cost model. We assumed loading doses based on the protocols of such trials. Costs were obtained at 2023 Medicare rates using the average sales price of each drug plus 6% per the Medicare allowable payments for Part B drugs or the wholesale acquisition cost plus 1.35%. We included the cost of office visits and OCT imaging as well as the complication of endophthalmitis in our model.
Results :
For nAMD, the 2-year cost of faricimab and aflibercept 8 mg is $27,915.49 and $26,337.58 respectively. For DME, the estimated average cost is $35,344.96 and $26,305.16 for faricimab and aflibercept 8 mg, respectively. The 2-year cost of faricimab treatment at intervals of q8 weeks, q12 weeks, and q16 weeks is less than that of aflibercept 2mg if receiving less than 17.3, 13.6, and 11.1 aflibercept 2mg injections over 2 years. The 2-year cost of aflibercept 8mg treatment at intervals of q8 weeks, q12 weeks, q16 weeks, q20 weeks, and q24 weeks is less than that of aflibercept 2mg if receiving less than 19.3, 13.8, 11.0, 9.6 and 8.3 aflibercept 2mg injections over 2 years.
Conclusions :
Aflibercept 8mg was less costly than faricimab for DME but similar for nAMD. Q12 week regimens of aflibercept 8mg and faricimab were cost effective only if on average, 7 or more aflibercept 2 mg injections were needed annually over 2 years. The cost benefits of aflibercept 8 mg and faricimab are not realized until approximately 2 years after treatment is initiated because of the relatively high costs and frequency of the initial loading therapy.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.