Swiss Analysis Shows Biosimilars Cut Costs but Longer-Interval Options Lead Savings

Widening interest in biosimilar adoption has renewed discussion in Switzerland about how closely priced follow-on agents compare with emerging extended-interval anti-VEGF options. A new cost-minimization analysis offers insight into this question by quantifying how ranibizumab biosimilars stack up financially against their reference product and against both doses of aflibercept for neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME).

Explore the cost-effectiveness of ranibizumab biosimilars versus aflibercept in treating AMD and DME, revealing significant savings and treatment implications. | Image credit: Syda Productions - stock.adobe.com

As Swiss payers continue to evaluate ways to control spending for chronic retinal diseases, biosimilars represent a potential mechanism for reducing direct health care costs without compromising clinical outcomes. Anti–vascular endothelial growth factor (VEGF) therapy remains the standard of care for both nAMD and DME, with treatment costs largely driven by medication pricing and injection frequency. With multiple ranibizumab biosimilars now marketed in Switzerland, the study aimed to clarify how much these agents reduce overall expenditures relative to reference ranibizumab and how their total 2-year costs compare with the more recently introduced higher-dose aflibercept 8 mg.

The model assessed unilateral treatment using real-world Swiss price data and injection frequencies derived from randomized trials. It assumed equivalent clinical outcomes across all evaluated therapies, which included aflibercept 2 mg, aflibercept 8 mg, faricimab, reference ranibizumab, and three ranibizumab biosimilars. The analysis was conducted from the health care payer perspective.

Across both disease areas, ranibizumab biosimilars generated meaningful cost savings relative to their reference product. In nAMD, the biosimilars’ 2-year total costs ranged from CHF 16,243 ($20,200) to CHF 17,618 ($21,900)—representing savings of approximately CHF 800 to CHF 2,200 per individual when compared with reference ranibizumab (CHF 18,424; $22,950). Similar results were seen in DME, where biosimilar costs ranged from CHF 18,187 ($22,600) to CHF 19,596 ($24,400), compared with CHF 20,637 ($25,700) for the reference product. These findings reflect the direct impact of lower acquisition costs, as injection frequencies for reference and biosimilar ranibizumab were assumed to be equivalent.

However, when biosimilars were compared with aflibercept products, the picture shifted. Aflibercept 2 mg carried higher overall 2-year costs than the biosimilars for both nAMD and DME, largely due to higher injection frequency. In nAMD, aflibercept 2 mg costs CHF 15,632 ($19,480)—slightly lower than the biosimilars but still higher than aflibercept 8 mg. In DME, the biosimilars were costlier than aflibercept 2 mg, which totaled CHF 15,243 ($18,990), with the difference driven by dosing intervals derived from clinical trial protocols.

Aflibercept 8 mg, designed to extend treatment intervals to as long as 16 weeks in some individuals, was consistently the lowest-cost therapy across both conditions. Its 2-year total cost was CHF 11,814 ($14,700) in nAMD and CHF 11,242 ($14,010) in DME—substantially lower than all ranibizumab products, including biosimilars. These savings stemmed from reduced injection frequency rather than drug price.

The study authors also performed break-even analyses to estimate how much biosimilar ranibizumab prices or injection frequencies would need to change to match the costs of aflibercept 8 mg. In nAMD, biosimilars would require price reductions of 55% to 59%. In DME, reductions of 76% to 79% would be needed. Similar patterns were observed for injection frequency: biosimilars would require 36% to 46% fewer injections in nAMD and up to 58% fewer in DME.

These findings highlight a central tension in the Swiss retina market. While biosimilars offer immediate, predictable price reductions compared with reference ranibizumab, the introduction of extended-interval therapies—particularly aflibercept 8 mg—shifts the cost landscape by reducing service utilization rather than drug unit cost. For conditions that require long-term maintenance therapy, fewer injections translate directly into reduced administration and visit costs.

The study had several limitations. Injection frequencies were based on clinical trials rather than real-world data, which may change as clinicians gain experience with newer products. The model assumed equivalent clinical outcomes among all agents, did not incorporate safety or adherence considerations, and used a 2-year horizon that may not reflect longer-term treatment patterns.

Even with these limitations, the analysis underscores that ranibizumab biosimilars meaningfully reduce costs relative to their reference product and offer a lower-cost alternative to aflibercept 2 mg, depending on disease area. However, the cost advantages of biosimilars are insufficient to offset the significantly reduced injection burden associated with aflibercept 8 mg, which remains the lowest-cost overall option in this model.

For Swiss health care payers and clinicians balancing immediate price savings against long-term resource use, these findings provide useful context for formulary decisions and treatment planning as biosimilar competition expands and extended-interval options continue to enter the market.