First-year Single Eye Treatment Cost Lowest With Bevacizumab for AMD, DME

Bevacizumab (BEV) was found to have the lowest first-year single eye (FYSE) cost for the treatment of age-related macular degeneration (AMD) and diabetic macular edema (DME) due to its lower claim cost for a single eye, according to a poster presented at AMCP 2023.

AMD and DME are the leading causes of visual impairment in the United States, with 1.8 million people being affected by them. Ophthalmic vascular endothelial growth factor inhibitors (OVEGFi), including BEV, are the most recommended treatment for the diseases. Understanding FYSE cost for these treatments can help to create management strategies for those affected. This poster revealed the results of evaluating FYSE cost for the most commonly used OVEGFi—aflibercept (ALF), BEV, and ranibizumab (RAN)—through assessing maintenance frequency and single-eye claim costs.

A total of 12.7 million commercial and 600,000 Medicare members provided medical OVEGFi claims data from October 2020 to March 2021. Those who had continuous enrollment 6 months prior and 12 months after the first claim with no OVEGFi claims in the 6 months before the first claim were considered new start members. AMD and DME were determined using International Classification of Diseases, Tenth Edition codes.

OVEGFi maintenance frequency was defined as the average days between claims after loading doses. The loading doses for ALF and RAN were 3 doses in 84 days for patients with AMD, whereas the loading dose for ALF was 5 doses in 140 days for patients with DME. The average allowed cost per unit multiplied by total units of a single-eye dose was equivalent to the single-eye claim cost. The FYSE cost was calculated as the single-eye claim cost multiplied by the expected number of first-year doses.

Commercial FYSE cost for AMD was $18,063, $951, and $16,390 for ALF, BEV, and RAN, respectively, when the maintenance frequency was 46, 48, and 43 days. The single-eye claim cost was $1983, $125, and $1719, respectively. Commercial FYSE cost for DME was $21,974, $931, and $7379 when the maintenance frequency was 37, 49, and 51 days, respectively. The single-eye claim cost was $1983, $125, and $1031.

The cost of Medicare FYSE treatment for AMD was $13,412, $536, and $12,816 for maintenance frequency of 55, 49, and 51 days, respectively. The single eye claim cost was $1654, $72, and $1506. The cost of Medicare FYSE treatment for DME was $16,188, $571, and $6463 when the maintenance frequency was 47, 46, and 51 days. The single-eye claim costs were $1654, $72, and $903.

There were differences in the groups regarding disease severity, gender, age, drug efficacy, and reasons for the varying frequencies in dosage. The investigators did not adjust for site of service and fee-schedule strategies when evaluating single-eye treatment cost. Drug rebates and cash-paid claims were also not captured in claims data.

The researchers concluded that BEV had the lowest cost for FYSE treatment of AMD and DME due to the low single-eye cost. RAN had a lower cost than ALF for FYSE treatment of both AMD and DME due to lower single-eye claim cost and the less frequent maintenance.

Reference

Vishwanath S, Montalbo A, Sharma S, Eckwright D. Ophthalmic vascular endothelial growth factor inhibitors: first-year single-eye therapy cost evaluation using real-world maintenance frequency and claim costs for aflibercept, bevacizumab, and ranibizumab. Presented at: Academy of Managed Care Pharmacy Annual Meeting; March 21-24, 2023; San Antonio, TX.