Anti-VEGFs for Diabetic Macular Oedema: Analysis of Efficacy, Safety, and Cost of More Durable Therapies from a Dutch Societal Perspective

IntroductionFrequent intravitreal injections of anti-vascular endothelial growth factors (VEGFs) for diabetic macular oedema (DMO) pose challenges for healthcare systems, patients, and society. This study assessed the efficacy, safety, resource utilization, and costs of anti-VEGFs from a Dutch societal perspective.MethodsA systematic literature review and indirect treatment comparison (ITC) compared the efficacy and safety of aflibercept 8 mg with aflibercept 2 mg, ranibizumab, faricimab, and bevacizumab. A Markov model estimated lifetime costs for unilateral or bilateral DMO treatment over 5 years from a Dutch societal perspective. Break-even prices determined the cost-neutral price for each anti-VEGF compared to the least expensive option.ResultsThe ITC found no significant differences in efficacy or safety among anti-VEGFs, leading to a cost-minimisation analysis. Over 5 years, the mean number of injections ranged from 15.0 (aflibercept 8 mg, flexible Q16 regimen) to 24.9 (bevacizumab, pro re nata regimen). Bevacizumab had the lowest 5-year per-patient cost (<euro>80,315). Aflibercept 8 mg followed at <euro>83,577, with a break-even price of <euro>560 per injection (- 23% vs. current price). Aflibercept 2 mg (fixed regimen), faricimab, and ranibizumab (treat-and-extend) required price reductions of 74%, 63%, and 71%, respectively, to match bevacizumab.ConclusionDespite similar efficacy and safety, differences in treatment burden were identified among the anti-VEGFs, with the more durable regimen of aflibercept 8 mg potentially reducing overall injection frequency compared to current care. Nevertheless, on the basis of current list prices, bevacizumab is the least expensive anti-VEGF for treating DMO. Aflibercept 8 mg, aflibercept 2 mg, faricimab, and ranibizumab could achieve cost-equivalence to bevacizumab if their medication prices were reduced by at least 23%, 74%, 63%, and 71%. These results could support future decision-making of healthcare providers and payers, encompassing aspects of medical costs, healthcare capacity use, and burden on patients as well as the healthcare system as a whole.