OBJECTIVES: Neovascular age-related macular degeneration (nAMD) is a widespread cause of visual impairment, with intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents being effective treatments. In the United Kingdom, patients receive ranibizumab, its biosimilars, aflibercept 2mg, brolucizumab, the more recently approved faricimab, or aflibercept 8mg. These latter two therapies demonstrated longer durability in clinical trials and may lead to fewer injections in clinical practice.

This study investigated whether the higher acquisition costs of faricimab or aflibercept 8mg compared to biosimilars are offset by the potential reduced healthcare resource use associated with fewer injections.

METHODS: A durability model was developed based on equivalent clinical outcomes, considering the number of annual injections and their associated drug and healthcare resource costs. A literature review, including National Institute for Health and Care Excellence (NICE) technology appraisals, was conducted to identify sources of the number of injections of ranibizumab, aflibercept 2mg, and faricimab in clinical practice. Cost data were derived from the National Schedule of National Health Service (NHS) Costs 2021/22, British National Formulary, and Bayer website.

RESULTS: The analysis shows that for budget neutrality with ranibizumab biosimilars, faricimab injections would need to be administered 5.25 and 4.10 times in years 1 and 2, respectively, versus 6.79, and 4.69 based on phase 3 clinical trials. Budget neutrality with aflibercept 8mg would be achieved at 4.74 and 3.70 injections in years 1 and 2.

With aflibercept 2mg, faricimab injections would need to be reduced to 5.76 and 4.05 in years 1 and 2 to achieve budget neutrality, while aflibercept 8mg injections could not exceed 5.20 and 3.66.

CONCLUSIONS: The study showed that ranibizumab biosimilars and aflibercept 2mg remain effective, innovative, and potentially cost-saving treatment options for retinal conditions such as nAMD.

While faricimab and aflibercept 8mg show potential benefits in durability, their higher acquisition costs require careful evaluation against budget constraints.