Pegcetacoplan treatment for geographic atrophy (GA) appears to be more cost-effective when used every other month rather than monthly, according to this 2-year cost analysis, though either option is expensive. With limited visual benefits long term, the possible implications of either option on patient quality of life should be considered.
Study Design
This retrospective cost analysis evaluated the cost-effectiveness of pegcetacoplan treatment for GA using data from the DERBY and OAKS studies, which evaluated the safety and efficacy of pegcetacoplan for GA, and 2022 Medicare reimbursement data. Primary outcomes included 2-year and estimated lifetime costs (costs of injections, OCT, and clinic visits), including estimations of costs per millimeter of GA area saved. Secondary analyses investigated the proportions and costs of different components of care, costs per retinal pigment epithelial cell saved, and costs per day that GA deterioration was delayed.
Outcomes
At the outset, the average area of GA in the DERBY and OAKS trials was 8.26 mm2. After 2 years, this area had increased to 12.26 mm2 (sham treatment), 11.46 mm2 (every other month [EOM] treatment), and 11.56 mm2 (every month [EM] treatment). The 2-year cost to treat GA in the EM and EOM treatment groups was $70,000 and $34,600, respectively. Costs per area of GA saved were $87,300/mm2 (EM) and $49,200/mm2 (EOM); the treatment of extrafoveal lesions was more cost-effective than the treatment of patients overall in each group. The daily cost of delaying GA progression by 7.8 months (EM) or 6.7 months (EOM) was estimated at $295 and $170, respectively. The modeled lifetime costs were $350,000 (EM) and $172,000 (EOM).
Limitations
The major limitations of this study include assumptions made in a lifetime analysis with a hypothetical model of GA progression that is based on only 2 years of data. In addition, the true rate and severity of choroidal neovascularization development is unknown after only 2 years.
Clinical Significance
The DERBY and OAKS studies have already demonstrated that the treatment of GA yields no true functional benefit at 2 years, and thus is not very cost-effective. That said, there may be some quality-of-life benefit for select patients. This cost analysis showed that every-other-month treatment of GA with intravitreal pegcetacoplan was more cost-effective than monthly treatment. In addition, the treatment of extrafoveal lesions yielded greater utility than treatment of the entire group under both EM and EOM treatments. The question is, when weighing the (likely small) lifetime quality-of-life benefit against the financial costs of pegcetacoplan treatment and considering the difficulties inherent in EM or EOM injections, is pegcetacoplan a feasible and beneficial treatment for our patients? The cost–benefit ratio of treatment, regardless of injection frequency, is likely very patient-specific. Patients who can travel easily to clinic visits or who are not as bothered by the injection procedure, as well as those with extrafoveal GA, may achieve significantly more quality-of-life benefit than patients who have difficulty with transportation, find the injections intolerable, or already have subfoveal GA.
Financial Disclosures: Dr. Lisa Schocket discloses no financial relationships.