Cost-minimisation analysis of anti-VEGF therapies in neovascular age-related macular degeneration and diabetic macular oedema in Switzerland

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.

本研究针对瑞士境内单侧新生血管性年龄相关性黄斑变性（unilateral neovascular age-related macular degeneration, nAMD）与糖尿病性黄斑水肿（diabetic macular oedema, DMO）患者，对比了包括按需延长给药（treat-and-extend, T&E）在内的抗血管内皮生长因子（anti-VEGF）疗法及其他长效给药方案的直接医疗成本。本研究采用改良版成本最小化模型，基于临床试验注射频次，对阿柏西普（aflibercept）2mg、阿柏西普（aflibercept）8mg、法瑞西单抗（faricimab）、雷珠单抗（ranibizumab）及其生物类似药的两年期医疗成本进行了估算。盈亏平衡分析用于确定高成本疗法需达到的药品价格与注射频次，方可与最低成本疗法实现成本平价。单因素敏感性分析（one-way sensitivity analysis, OWSA）则评估了成本结局的关键影响因素。估算结果显示，阿柏西普8mg在两种适应症中均拥有最低治疗成本（nAMD患者为11,814瑞士法郎（CHF）；DMO患者为11,242瑞士法郎（CHF））；其次分别为法瑞西单抗（nAMD患者为13,737瑞士法郎）与阿柏西普2mg（DMO患者为15,243瑞士法郎）。雷珠单抗及其生物类似药的治疗成本最高：针对nAMD，其生物类似药的成本区间为16,243至17,497瑞士法郎，原研药成本达18,424瑞士法郎；针对DMO，生物类似药成本区间为18,187至19,596瑞士法郎，原研药成本为20,637瑞士法郎。针对nAMD的盈亏平衡分析显示，相较于阿柏西普8mg，法瑞西单抗的价格需下降22%（至644瑞士法郎），雷珠单抗原研药需下降64%（至218瑞士法郎）；针对DMO，价格降幅区间为42%（阿柏西普2mg，降至493瑞士法郎）至81%（雷珠单抗原研药，降至114瑞士法郎）。单因素敏感性分析结果显示，药品价格与注射频次是影响治疗成本的核心驱动因素。本研究估算表明，临床试验方案中阿柏西普8mg的潜在最低注射频次，可使nAMD与DMO患者获得最低治疗成本，其次分别为法瑞西单抗（针对nAMD）与阿柏西普2mg（针对DMO）。