Yanagi Yasuo, Tsujimura Jun, Ohno Shinya, Higashi Kentaro, Sakashita Naotaka, Shoji Ayako, Igarashi Ataru
Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Japan.
Retina Research Group, Singapore Eye Research Institute, Singapore.
J Med Econ. 2025 Dec;28(1):448-459. doi: 10.1080/13696998.2025.2478755. Epub 2025 Mar 23.
To assess the cost-effectiveness of faricimab other anti-vascular endothelial growth factor (anti-VEGF) drugs for treatment of neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) in Japan, while considering societal burden associated with treatment.
A Markov model for cost-effectiveness analysis of anti-VEGF treatment in patients with nAMD and DME was applied based on cost and utility value data from Japan. Faricimab administered through a treat-and-extend (T&E) regimen was compared with ranibizumab administered pro re nata (PRN) and T&E, aflibercept T&E, brolucizumab T&E, and best supportive care (BSC). Further to treatment costs (public payer perspective), the societal burden (societal perspective), including costs of travel, informal care, and productivity, was assessed.
In treatment of nAMD, lifetime quality-adjusted life years (QALYs) gained were highest with faricimab (faricimab T&E: 6.92, ranibizumab PRN: 6.88, ranibizumab T&E: 6.91, aflibercept T&E: 6.89, brolucizumab T&E: 6.89, BSC: 5.99). From the public payer perspective, the lifetime total cost for faricimab T&E was lower than those for ranibizumab (PRN, T&E) and brolucizumab (T&E), comparable to aflibercept T&E, and higher than BSC (incremental costs: 158,385 and 6,475,511 JPY, respectively). As a result, faricimab was cost-effective or dominant in the treatment of nAMD, excluding BSC. From the societal perspective, faricimab was dominant against all comparators in nAMD. In treatment of DME, QALYs gained were highest with faricimab (faricimab T&E: 8.51, ranibizumab PRN: 8.17, aflibercept PRN: 8.36, ranibizumab T&E: 8.13, BSC: 5.16). From both the public payer and societal perspectives, faricimab was dominant against all comparators in DME.
When societal burdens were considered, faricimab was dominant in both nAMD and DME against all comparators, suggesting that the extended dosing interval associated with faricimab treatment may alleviate societal burdens and consequently improve patient outcomes.
在考虑治疗相关社会负担的情况下，评估法西单抗与其他抗血管内皮生长因子（anti-VEGF）药物治疗日本新生血管性年龄相关性黄斑变性（nAMD）和糖尿病性黄斑水肿（DME）的成本效益。
基于日本的成本和效用值数据，应用马尔可夫模型对nAMD和DME患者的抗VEGF治疗进行成本效益分析。将通过治疗并延长（T&E）方案给药的法西单抗与按需（PRN）和T&E方案给药的雷珠单抗、阿柏西普T&E、布罗达单抗T&E以及最佳支持治疗（BSC）进行比较。除治疗成本（公共支付方视角）外，还评估了社会负担（社会视角），包括交通、非正式护理和生产力成本。
在nAMD治疗中，法西单抗获得的终身质量调整生命年（QALY）最高（法西单抗T&E：6.92，雷珠单抗PRN：6.88，雷珠单抗T&E：6.91，阿柏西普T&E：6.89，布罗达单抗T&E：6.89，BSC：5.99）。从公共支付方视角来看，法西单抗T&E的终身总成本低于雷珠单抗（PRN、T&E）和布罗达单抗（T&E），与阿柏西普T&E相当，高于BSC（增量成本分别为158,385日元和6,475,511日元）。因此，除BSC外，法西单抗在nAMD治疗中具有成本效益或占主导地位。从社会视角来看，法西单抗在nAMD治疗中相对于所有对照药物均占主导地位。在DME治疗中，法西单抗获得的QALY最高（法西单抗T&E：8.51，雷珠单抗PRN：8.17，阿柏西普PRN：8.36，雷珠单抗T&E：8.13，BSC：5.16）。从公共支付方和社会视角来看，法西单抗在DME治疗中相对于所有对照药物均占主导地位。
当考虑社会负担时，法西单抗在nAMD和DME治疗中相对于所有对照药物均占主导地位，这表明法西单抗治疗相关的延长给药间隔可能减轻社会负担，从而改善患者预后。
