Ranibizumab port delivery system shows mixed cost-utility results in treating age-related macular degeneration

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The ranibizumab port delivery system (Susvimo) demonstrated cost-effectiveness compared to intravitreal ranibizumab injections for the treatment of neovascular age-related macular degeneration (nAMD) in the short term (one year), according to a study. However, over longer periods (5 and 12 years), the cost-effectiveness diminished, and the intravitreal injection therapy showed a more favorable 12-year average cost-utility ratio.

Vision gain was identified as a critical factor influencing participant value gain for both interventions, and both approaches were deemed highly cost-effective when assessed using an average cost-utility analysis with a societal cost perspective.

Participants from the Archway Phase 3 clinical trial who had previously responded to anti-VEGF therapy were randomized, with 240 receiving port delivery system (PDS) refills every 24 weeks and 162 receiving intravitreal ranibizumab injections.

The 1-year results indicated a significant quality-adjusted life-year (QALY) gain with the PDS at 5.9%, compared to 0.82% with intravitreal injections. However, the 12-year QALY gains showed no significant difference between the two treatments. The 1-year incremental cost-utility ratio ($/QALY) favored the PDS at $75,497/QALY, indicating cost-effectiveness. However, the 5-year and 12-year ratios for the PDS were $304,108/QALY and $761,646/QALY, respectively, suggesting diminished cost-effectiveness over a more extended period.

Direct ophthalmic costs for PDS and intravitreal injections were $21,825 and $18,405, respectively, over 1 year. The 12-year average cost-utility ratios were $78,773/QALY for the PDS and $47,917/QALY for injection therapy.

When considering societal costs, the study found a net gain of $314,521 to society per PDS participant compared to $370,958 per participant for injection therapy, after offsetting -$476,442 in 12-year societal costs.

Brown GC, Brown MM, Monigle MC. Cost-Utility Analysis of the Port Delivery System with Ranibizumab for Neovascular Age-Related Macular Degeneration. Ophthalmol Retina. 2023;S2468-6530(23)00578-X. doi: 10.1016/j.oret.2023.11.002. Epub ahead of print. PMID: 37981235.