Study suggests anti-VEGF biosimilars will increase overall health care costs
A bevacizumab biosimilar pending approval from the US Food and Drug Administration could lead to a significant increase in the cost of intravitreal anti-VEGF medications, according to a cost analysis study published in Ophthalmology.
The pending approval of bevacizumab-vikg biosimilar may paradoxically increase the cost burden of intravitreal anti-VEGF, as “off-label” repackaged drug may no longer be allowed per the Drug Quality and Security Act (DQSA).
The study analyzed Medicare data from October 2022 and previously published market share data from 2019 to calculate the average sales price (ASP) of ranibizumab, aflibercept, and bevacizumab. The ASPs of biosimilars were calculated from wholesale acquisition costs from a representative distributor. The cost of an intraocular bevacizumab formulation was modeled at $500 and $900/1.25mg dose.
The main outcome measures were the overall costs of anti-VEGF drugs to Medicare Part B and patients. The results showed that if an intraocular bevacizumab biosimilar were to be priced at $500, costs to Medicare would increase by $457 million from $3.01 billion to $3.47 billion (15.2% increase). Patient responsibility would increase by $117 million from $768 million to $884 million. Similarly, if intraocular bevacizumab were priced at $900, Medicare costs would increase by $897 million to $3.91 billion (29.8% increase), and patient responsibility would increase by $229 million to $997 million.
The study also found that if bevacizumab were $500/dose, switching all patients currently on ranibizumab or aflibercept to respective biosimilars would only compensate for 28.8% of the increased cost. Current prices of ranibizumab and aflibercept biosimilars would have to decrease by an aggregate of 15.7% to $616.80, $1027.97, and $1436.88/injection for ranibizumab 0.3 mg, 0.5 mg, and aflibercept, respectively.
The authors concluded that “The data support the need for an exemption of section 503B of the DQSA and continued use of repackaged off-label bevacizumab.”
Zhang C, Friedman S, Mruthyunjaya P, et al. The Biosimilar Paradox: How Anti-VEGF Biosimilars will Increase Patient and Overall Healthcare Costs. Ophthalmology. 2023;S0161-6420(23)00295-6. doi: 10.1016/j.ophtha.2023.04.019. Epub ahead of print. PMID: 37116720.
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