Ranibizumab PDS Costlier Than Intravitreal Ranibizumab, Aflibercept for nAMD

Shefali Sood, MD, MPA

A new cost analysis indicated that ranibizumab port delivery system (PDS) with 1 refill was costlier than intravitreal ranibizumab and aflibercept injection if less than or equal to 11 and 10 injections were given within the first year of treatment for neovascular age-related macular degeneration (nAMD).

Previous research has suggested that roughly 288 million people globally will be affected by age-related macular degeneration by 2040. Though only 10-15% of all AMD cases are nAMD, the condition has been attributable to 90% of AMD-related visual impairment prior to anti-vascular endothelial growth factor (VEGF) drugs.

Though various anti-VEGF function in similar ways and result in significant visual gains, the prices of these treatments vary.

Earlier in 2022, the US Food and Drug Administration approved the first PDS with sustained delivery of ranibizumab after phase 3 data indicated that 98% of patients treated with ranibizumab PDS were stable with 24-week refills.

For the current study, an investigative team led by Shefali Sood, MD, MPA, of the New York University School of Medicine, sought to determine the cost differences between intravitreal injections of ranibizumab, bevacizumab, and aflibercept compared with ranibizumab PDS use for the treatment of nAMD.

The Methods

Initially, Sood and colleagues amassed data from 2 investigational studies on the PDS, which included one phase 3 trial and one phase 2 trial, the latter of which was used to model pro re nata (PRN) dosing of PDS refills.

Meanwhile, cost information for ranibizumab PDS implantation and refills was obtained for the 2022 Centers for Medicare and Medicaid (CMS) Physician Fee Schedule, while additional data was accessed through the manufacturer.

Ambulatory Surgical Center facility and professional fees were collected via Medicare Procedure Look-Up Tool, while the PDS Implantation Kit costs were collected from the manufacturer at wholesale acquisition costs (WAC).

Additional costs, which included office visits featuring optical coherence tomography (OCT) imaging, were also considered. The team excluded the cost of fluorescein angiography.

Differences in Cost

Investigators noted that the cost of ranibizumab PDS with fixed 6-month refills over 1 year was $21,016, while the monthly intravitreal cost of ranibizumab was $1943 (P=.34) less.

Additionally, the monthly intravitreal costs were $5702 and $16,732 less for aflibercept and bevacizumab, respectively. Regarding bimonthly injections, aflibercept cost %7658 less than ranibizumab PDS.

Over a 5-course period, investigators noted that that the projected cost of monthly intrvitreal ranibizumab was $25,581 (P=.04) more than PDS. Meanwhile, aflibercept cost (P = .008) more, and bevacizumab cost $67 793 (P < .001) less than PDS with fixed refills.

Finally, aflibercept cost $22 422 ( P = .03) less when administered in bimonthly.

Given the data amassed in the study, investigators suggested that the use of PDS would be motivated by factors other than cost, such as safety, preferred practice, and willingness to undergo surgery involving frequent clinic visits.

“Further research on the ranibizumab PDS long-term safety, efficacy, and cost effectiveness is warranted,” the team wrote.

The study, "Cost of Ranibizumab Port Delivery System vs Intravitreal Injections for Patients With Neovascular Age-Related Macular Degeneration," was published online in JAMA Ophthalmology.