Which VEGF-inhibitor for neovascular AMD has the best return-on-investment?
In this cost-benefit analysis, published clinical trial and Medicare data of 168,400 estimated patients in the United States with new-onset NVAMD in 2018 were analyzed to compare the societal cost-benefit of intravitreal bevacizumab, ranibizumab, and aflibercept monotherapies.
Bevacizumab
Individual 11-year cost: $14,772
Net societal return: $357,680
Ranibizumab
Individual 11-year cost: $106,582
Net societal return: $265,870
Aflibercept
Individual 11-year cost: $61,811
Net societal return: $310,611
In the 2018 overall treatment cohort of patients with NVAMD, the 11-year net societal gain was $28.5 billion to patients and insurers. Approximately 85% ($24.2B) came from bevacizumab therapy, 2.5% ($0.7B) came from ranibizumab, and 12.6% ($3.6B) from aflibercept therapy.
An estimated $1.343 billion over 11 years would be saved if bevacizumab was substituted for ranibizumab and aflibercept in the 2018 patients with new-onset NVAMD.
The 11-year contribution to the Gross Domestic Product in 2018 dollars from vascular endothelial growth factor-inhibitor therapy for this cohort of patients was $12.2 billion.
Reference
Brown GC, Brown MM, Rapuano SB, et al. A cost-benefit analysis of VEGF-inhibitor therapy for neovascular age-related macular degeneration in the United States. Am J Ophthalmol. 2020; DOI:https://doi.org/10.1016/j.ajo.2020.07.010
