Cost-Effectiveness of Aflibercept or Bevacizumab Plus Aflibercept for DME
By Jean Shaw
Selected and reviewed by Neil M. Bressler, MD, and Deputy Editors
Journal Highlights
JAMA Ophthalmology, March 2023
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Hutton et al. set out to assess the cost and cost-effectiveness of two anti-VEGF strategies for treating diabetic macular edema (DME). They found that, for eyes with vision loss from DME, treating with repackaged (compounded) off-label bevacizumab first and then switching to aflibercept as needed may confer substantial cost savings without sacrificing gains in VA.
For this study, the researchers analyzed cost data from the DRCR Retina Network Protocol AC, assessing the incremental cost-effectiveness ratio (ICER) in cost per quality-adjusted life-year (QALY) over two years.
Protocol AC involved 228 participants with center-involved DME and BCVA of 20/50 to 20/320. Per study design, 116 participants received aflibercept alone, while 112 were enrolled in the bevacizumab-first cohort. (Of these, nearly two-thirds were eventually switched to aflibercept because of suboptimal response to bevacizumab.)
The cost of aflibercept monotherapy was $26,504 (95% CI, $24,796-$28,212). In contrast, the cost of bevacizumab-first treatment was $13,929 (95% CI, $11,984-$15,874), wherein 70% of the participants had been switched to aflibercept by two years. Those who received aflibercept only gained .015 QALYs using the better-seeing eye and had an ICER of $837,077 per QALY gained compared with the bevacizumab-first group.
The researchers estimated that aflibercept monotherapy may be cost-effective if the per-dose price drops to $300 or less—or the price of bevacizumab rises to $1,307 per dose. Moreover, using 2022 prices for every 10,000 new patients starting therapy for DME, the bevacizumab-first strategy could lead to a cost savings of more than $125 million in the United States.
The original article can be found here.