Anti-VEGFs May Provide Substantial Economic Value to Patients and Society in Treating Wet AMD

The field of biosimilar contenders for anti—vascular endothelial growth factor (anti-VEGF) therapies is taking shape, with biosimilar developer Coherus seeking to launch its ranibizumab biosimilar in 2021 and Samsung Bioepis having reached a commercialization agreement for 2 biosimilar anti-VEGFs of its own. Last week, a study published in JAMA Ophthalmology supported the use of anti-VEGF agents in wet age-related macular degeneration (AMD), saying that, though these drugs are costly, they may provide substantial economic value to both patients and society.¹

The economic evaluation study used data from the published literature to simulate vision outcomes for a cohort of 168,820 patients with wet AMD. The researchers assumed the cohort was aged 65 years or older, and that baseline visual acuity (VA) was 55 letters. They considered 2 treatment scenarios: one in which patients receive approximately 8.2 (standard deviation [SD] 1.6) injections each year, and one in which patients receive approximately 10.5 (range, 6.8-13.1) injections each year (the second scenario reflects dosing for ranibizumab).

VA was translated into quality-adjusted life-years (QALYs) at a conversion rate of $150,000 per QALY gained.

From an individual patient standpoint, the VA improvements in the first scenario translated into $10,918 in economic benefits at 1 year, $32,158 at 3 years, and $49,558 at 5 years. The second scenario generated $15,525, $50,839, and $84,873 in benefits at the same 3 time points.

For the full cohort, the first scenario generated $1.1 billion in patient benefits in year 1, and the second scenario generated $1.6 billion. At 3 years, patient benefits from the first scenario increased to $5.1 billion, and patient benefits from the second scenario increased to $8.2 billion. Societal value, measured as patient benefits net of treatment cost, ranged from $0.9 billion to $3.0 billion across 3 years.

Additionally, the authors note that using bevacizumab off-label, instead of using aflibercept or ranibizumab, in 72% of the market (up from a current 55% of the market) could bring down total costs to treat the full population by $1.8 billion to $2.2 billion over 3 years.

If patient outcomes match the data used in these analyses, say the authors, improved vision associated with anti-VEGF treatment could provide substantial value to patients and society. Innovations that improve adherence, such as improved drug delivery, could provide even more value.

In a linked commentary, Melissa M. Brown, MD, MN, MBA, and Gary C. Brown, MD, MBA, write that they find the $150,000 per QALY measure to be “somewhat arbitrary,” however, and suggested that different anti-VEGF therapy percentage weights could have been used in the analysis.² “Nonetheless,” they write, “the results likely still would have shown that patients and society retain substantial dollars with VEGF inhibitor therapy.” They add that, while most cost-utility analyses do not consider societal costs, “We agree with the authors that their type of analyses are key for ophthalmology, especially if the competition for health care dollars intensifies.”

References

1. Mulligan K, Seabury SA, Dugel PU, Blim JF, Goldman DP, Humayun MS. Economic value of anti—vascular endothelial growth factor treatment for patients with wet age-related macular degeneration in the United States [published online November 14, 2019]. JAMA Ophthalmol. doi: 10.1001/jamaophthalmol.2019.4557.

2. Brown MM, Brown GC. Economic evaluation of anti—vascular endothelial growth factor therapy for wet age-related macular degeneration [published online November 14, 2019]. JAMA Ophtalmol. doi:10.1001/jamaophthalmol.2019.4582.