Analysis Finds Ranibizumab PDS Cost-Saving in Long-term Scenarios

A study published in JAMA Ophthalmology found that the ranibizumab port delivery system (PDS) with refills as needed saved money over a 5-year period compared with regular ranibizumab or aflibercept injections when treating patients with neovascular age-related macular degeneration (nAMD). Ranibizumab and aflibercept injections were found to be cost-saving in shorter time spans.

This study used data from trials of ranibizumab PDS and patterns of anti–vascular endothelial growth factor (VEGF) drug use in patients with nAMD. The researchers investigated total costs of ranibizumab PDS and intravitreal anti-VEGF injections (ranibizumab, aflibercept, bevacizumab) for 1 year and 5 years to assess the number of anti-VEGF injections that were needed to break even on costs of ranibizumab PDS.

Cost information was taken from the 2022 CMS Physician Fee Schedule and information from the manufacturer for ranibizumab PDS.

The researchers found that the mean (SD) number of injections needed to break even with the cost of ranibizumab PDS implantation and medication was 6.4 (0.8) ranibizumab injections, 5.5 (0.7) aflibercept injections, and 34.5 (4.2) bevacizumab injections. To break even with the cost of ranibizumab PDS and 1 refill, 10.8 (1.3) ranibizumab injections, 9.3 (1.1) aflibercept injections, or 58.1 (7.1) bevacizumab injections were needed.

A mean of 15.2 (1.9) ranibizumab injections, 13.1 (1.6) aflibercept injections, or 81.6 (10.0) bevacizumab injections was needed to break even with the cost of PDS with 2 refills. Adding direct costs (eg, office visits with imaging) to the cost analysis did not affect the number of injections needed to break even with PDS cost.

When assessing fixed 6-month interval dosing, the mean (SD) cost of ranibizumab PDS with refills over 1 year was $21,016 ($2102). Comparatively, monthly ranibizumab, aflibercept, and bevacizumab injections cost $1943 more (95% CI, –$3047 to $6932), $5702 more (95% CI, $253-$11,151), and $16,732 less (95% CI, –$20,170 to –$13,294), respectively. Bimonthly injections of aflibercept cost $7658 less (95% CI, –$11,645 to –$3666) than ranibizumab PDS.

Pro re nata (PRN) refills for PDS had a mean (SD) total cost of $16,054 ($1605) over 1 year. Real-world ranibizumab injections cost $3878 less (95% CI, $648-$7108), aflibercept injections cost $2284 less (95% CI, $1106-$5675), and bevacizumab injections cost $13,931 less (95% CI, $11,335-$16,526) when compared with ranibizumab PDS with PRN refills.

The total cost of ranibizumab PDS with PRN refills was $45,755 ($4576) over a period of 5 years. Real-world intravitreal ranibizumab cost $15,129 more (95% CI, $2921-$27,337) and aflibercept injections cost $23,097 more (95% CI, $9845-$36,348) than ranibizumab PDS. However, the bevacizumab injections cost $35,136 less (95% CI, –$42,665 to $27,606) than ranibizumab PDS.

There were some limitations to this study. Data from the phase 2 and phase 3 clinical trials of the ranibizumab PDS were used, but some outcome measures and control groups were not included. The projected costs for the long term were based on practice pattern assumptions. The study also did not incorporate the effectiveness of the medications in question.

The researchers concluded that ranibizumab PDS could help save patients money when PRN refills were needed in a 5-year period. The authors also found that intravitreal anti-VEGF use saved more money when taken on a short-term basis of 1 year or less compared with fixed 6-month refills of ranibizumab PDS.

Further research would be required on the long-term safety, efficacy, and cost-effectiveness of ranibizumab PDS before further conclusions can be drawn, they added.

Reference

Sood S, Mandell J, Watane A, Friedman S, Parikh R. Cost of ranibizumab port delivery system vs intravitreal injections for patients with neovascular age-related macular degeneration. JAMA Ophthalmol. Published online June 16, 2022. doi:10.1001/jamaophthalmol.2022.1819