Ambresin Aude, Quist S W, Boer M, Maamari S, Barthelmes D
Swiss Visio Retina Research Center, Swiss Visio Montchoisi, Lausanne, Switzerland.
University Medical Center Groningen, Groningen, The Netherlands.
J Med Econ. 2025 Dec;28(1):1198-1213. doi: 10.1080/13696998.2025.2536420. Epub 2025 Jul 29.
This study compares the direct healthcare costs of anti-VEGF therapies, including treat-and-extend (T&E) and other durable regimens, for unilateral neovascular age-related macular degeneration (nAMD) and diabetic macular oedema (DMO) in Switzerland.
An adapted cost-minimisation model estimated healthcare costs over two years for aflibercept 2 mg, aflibercept 8 mg, faricimab, ranibizumab, and ranibizumab biosimilars using clinical trial injection frequencies. Break-even analyses identified the medication prices and injection frequencies required for higher-cost therapies to achieve cost parity with the least expensive options. A one-way sensitivity analysis (OWSA) assessed key drivers of cost outcomes.
Aflibercept 8 mg was estimated to be associated with the lowest treatment costs for both indications (CHF 11,814 for nAMD; CHF 11,242 for DMO). Faricimab (CHF 13,737) and aflibercept 2 mg (CHF 15,243) followed in nAMD and DMO. Ranibizumab and its biosimilars incurred the highest costs: for nAMD, biosimilars ranged from CHF 16,243 to CHF 17,497 and the reference product reached CHF 18,424; for DMO, biosimilars ranged from CHF 18,187 to CHF 19,596, with the reference product at CHF 20,637. Break-even analyses for nAMD showed that prices would need to drop by -22% (faricimab, CHF 644) to -64% (ranibizumab reference, CHF 218) relative to aflibercept 8 mg. For DMO, reductions ranged from -42% (aflibercept 2 mg, CHF 493) to -81% (ranibizumab reference, CHF 114). The OWSA highlighted medication price and injection frequency as primary cost drivers.
This study estimated that the potentially minimized injection frequency of aflibercept 8 mg in a clinical trial regimen may result in the lowest treatment costs for nAMD and DMO, followed by faricimab and aflibercept 2 mg, respectively.
本研究比较了瑞士抗血管内皮生长因子（VEGF）疗法（包括治疗并延长给药方案（T&E）和其他长效给药方案）用于治疗单侧新生血管性年龄相关性黄斑变性（nAMD）和糖尿病性黄斑水肿（DMO）的直接医疗费用。
采用一种经过调整的成本最小化模型，根据临床试验中的注射频率估算阿柏西普2mg、阿柏西普8mg、法西单抗、雷珠单抗及雷珠单抗生物类似药在两年内的医疗费用。盈亏平衡分析确定了成本较高的疗法与成本最低的疗法实现成本平价所需的药品价格和注射频率。单向敏感性分析（OWSA）评估了成本结果的关键驱动因素。
估计阿柏西普8mg用于这两种适应症的治疗成本最低（nAMD为11,814瑞士法郎；DMO为11,242瑞士法郎）。在nAMD和DMO治疗中，其次是法西单抗（13,737瑞士法郎）和阿柏西普2mg（15,243瑞士法郎）。雷珠单抗及其生物类似药的成本最高：对于nAMD，生物类似药的成本在16,243瑞士法郎至17,497瑞士法郎之间，参比产品达到18,424瑞士法郎；对于DMO，生物类似药的成本在18,187瑞士法郎至19,596瑞士法郎之间，参比产品为20,637瑞士法郎。nAMD的盈亏平衡分析表明，相对于阿柏西普8mg，价格需要降低-22%（法西单抗，644瑞士法郎）至-64%（雷珠单抗参比产品，218瑞士法郎）。对于DMO，降价幅度在-42%（阿柏西普2mg，493瑞士法郎）至-81%（雷珠单抗参比产品，114瑞士法郎）之间。单向敏感性分析突出了药品价格和注射频率是主要的成本驱动因素。
本研究估计，在临床试验方案中，阿柏西普8mg潜在的最低注射频率可能导致nAMD和DMO的治疗成本最低，其次分别是法西单抗和阿柏西普2mg。
