Bevacizumab Before Aflibercept for DME May Offer Major Cost Savings

Aflibercept monotherapy costs approximately $12,000 more than treating patients with diabetic macular edema (DME) with bevacizumab first, and then switching to aflibercept if response is suboptimal, according to a study published in JAMA Ophthalmology.

“While the bevacizumab-first group costs still averaged approximately $14,000 over 2 years, this approach … may confer substantial cost savings on a societal level without sacrificing visual acuity gains over 2 years compared with aflibercept monotherapy,” wrote first author David W. Hutton, PhD, of the University of Michigan School of Public Health, Ann Arbor, and study coauthors.

The economic evaluation included 228 patients with moderate or more severe vision loss from DME: 116 patients received aflibercept monotherapy, and 112 patients received bevacizumab first but switched to aflibercept if response to bevacizumab was suboptimal. Among patients who received bevacizumab first, 62.5% eventually switched to aflibercept over the 2-year study period.

According to the study, costs over 2 years were $26,504 for the aflibercept monotherapy group and $13,929 for the bevacizumab-first group.

Aflibercept monotherapy added 0.015 quality-adjusted life-years (QALYs) using the better-seeing eye. Compared with the bevacizumab first, aflibercept monotherapy had an incremental cost-effectiveness ratio of $837,077 per QALY gained, analysis showed.

“Aflibercept could be cost-effective with an incremental cost-effectiveness ratio of $100,000 per QALY if the price per dose were $305 or less,” researchers reported, “or the price of bevacizumab was $1307 per dose or more.”

Reference

Hutton DW, Glassman AR, Liu D, Sun JK; DRCR Retina Network. Cost-effectiveness of aflibercept monotherapy vs bevacizumab first followed by aflibercept if needed for diabetic macular edema. JAMA Ophthalmol. 2023;141(3):268-274. doi:10.1001/jamaophthalmol.2022.6142