For patients with neovascular age-related macular degeneration (nAMD), ranibizumab with a port delivery system (PDS) with one refill costs more than intravitreal ranibizumab or aflibercept injections if about 11 or 10 injections, respectively, or fewer are needed within the first year, according to a study published online June 16 in JAMA Ophthalmology.
Shefali Sood, M.D., from the New York University School of Medicine in New York City, and colleagues examined the costs of intravitreal antivascular endothelial growth factor injections versus ranibizumab PDS for patients with nAMD using trial data and Medicare reimbursement rates.
The researchers found that to break even with the cost of ranibizumab PDS with one refill, the mean number of ranibizumab, aflibercept, and bevacizumab injections was 10.8, 9.3, and 34.5, respectively. The cost for ranibizumab PDS with fixed six-month refills over one year was $21,016. Monthly intravitreal ranibizumab cost $1,943 more and aflibercept cost $5,702 more, while bevacizumab cost $16,732 less. Aflibercept cost $7,658 less for bimonthly injections. Compared with PDS with fixed refills, monthly intravitreal ranibizumab was projected to cost $25,581 more over five years, while aflibercept cost $44,374 more and bevacizumab cost $67,793 less. Compared with real-world ranibizumab or aflibercept, ranibizumab PDS with refills as needed offered cost savings at five years but not at one year.
“We demonstrate the cost-saving potential of ranibizumab PDS with PRN refill in patients receiving regular ranibizumab or aflibercept injections depending on number of injections and refills given,” the authors write.
Two authors disclosed financial ties to the pharmaceutical industry; one disclosed ties to an insurance company.