PMID- 34643793
OWN - NLM
STAT- MEDLINE
DCOM- 20220314
LR  - 20220316
IS  - 1435-702X (Electronic)
IS  - 0721-832X (Print)
IS  - 0721-832X (Linking)
VI  - 260
IP  - 4
DP  - 2022 Apr
TI  - Cost-minimisation analysis of a treat-and-extend regimen with anti-VEGFs in 
      patients with neovascular age-related macular degeneration.
PG  - 1083-1095
LID - 10.1007/s00417-021-05359-x [doi]
AB  - PURPOSE: Although intraocular anti-vascular endothelial growth factors 
      (anti-VEGFs) are effective as treatment of neovascular age-related macular 
      degeneration (nAMD), the (economic) burden on the healthcare system is 
      considerable. A treat-and-extend (T&E) regimen is associated with a lower number 
      of injections without compromising the effectiveness and can therefore help 
      optimise nAMD treatment. This study investigates the per-patient costs associated 
      with nAMD treatment, when using aflibercept, bevacizumab, or ranibizumab with a 
      T&E regimen. METHODS: In this cost-minimisation model, the per-patient costs in 
      the Netherlands were modelled using a healthcare payers' perspective over a 
      3-year time horizon with the assumption that efficacy of treatments is similar. 
      Additionally, the break-even price of the different anti-VEGFs was calculated 
      relative to the cheapest option and injection frequency. RESULTS: The injection 
      frequency varied from 14.2 for aflibercept to 27.4 for bevacizumab in 3 years. 
      Nonetheless, bevacizumab remains the cheapest treatment option (euro14,215), 
      followed by aflibercept (euro18,202) and ranibizumab (euro31,048). The medication 
      covers the majority of the per-patient costs for aflibercept and ranibizumab, 
      while administration covers the majority of the per-patient costs for 
      bevacizumab. The break-even prices of aflibercept and ranibizumab are 
      respectively euro507 and euro60.58 per injection. Brolucizumab was included in the 
      scenario analysis and was more expensive than aflibercept (euro20,446). Brolucizumab 
      should reduce to 13.8 injections over 3 years to be as costly as aflibercept. 
      CONCLUSION: Bevacizumab is the cheapest anti-VEGF treatment. The list prices of 
      all anti-VEGFs should reduce to be as costly as bevacizumab. Aflibercept is the 
      second-choice treatment and so far brolucizumab is not.
CI  - (c) 2021. The Author(s).
FAU - Quist, S W
AU  - Quist SW
AUID- ORCID: 0000-0003-3871-4239
AD  - Department of Health Sciences, University of Groningen, University Medical Center 
      Groningen, Hanzeplein 1, Groningen, The Netherlands. s.w.quist@student.rug.nl.
AD  - Asc Academics, Professor Enno Dirk Wiersmastraat 5, Groningen, The Netherlands. 
      s.w.quist@student.rug.nl.
FAU - de Jong, L A
AU  - de Jong LA
AD  - Department of Health Sciences, University of Groningen, University Medical Center 
      Groningen, Hanzeplein 1, Groningen, The Netherlands.
AD  - Asc Academics, Professor Enno Dirk Wiersmastraat 5, Groningen, The Netherlands.
FAU - van Asten, F
AU  - van Asten F
AD  - Department of Ophthalmology, Radboud University Medical Center, Philips Van 
      Leydenlaan 15, Nijmegen, The Netherlands.
FAU - Knoester, P
AU  - Knoester P
AD  - Department of Pharmacy, Alrijne Hospital, Simon Smitweg 1, Leiderdorp, The 
      Netherlands.
FAU - Postma, M J
AU  - Postma MJ
AD  - Department of Health Sciences, University of Groningen, University Medical Center 
      Groningen, Hanzeplein 1, Groningen, The Netherlands.
AD  - Department of Economics, Econometrics & Finance, University of Groningen, Faculty 
      of Economics & Business, Nettelbosje 2, Groningen, The Netherlands.
FAU - Freriks, R D
AU  - Freriks RD
AD  - Asc Academics, Professor Enno Dirk Wiersmastraat 5, Groningen, The Netherlands.
AD  - Department of Economics, Econometrics & Finance, University of Groningen, Faculty 
      of Economics & Business, Nettelbosje 2, Groningen, The Netherlands.
LA  - eng
PT  - Journal Article
DEP - 20211013
PL  - Germany
TA  - Graefes Arch Clin Exp Ophthalmol
JT  - Graefe's archive for clinical and experimental ophthalmology = Albrecht von 
      Graefes Archiv fur klinische und experimentelle Ophthalmologie
JID - 8205248
RN  - 0 (Angiogenesis Inhibitors)
RN  - 0 (Recombinant Fusion Proteins)
RN  - 2S9ZZM9Q9V (Bevacizumab)
RN  - EC 2.7.10.1 (Receptors, Vascular Endothelial Growth Factor)
RN  - ZL1R02VT79 (Ranibizumab)
SB  - IM
MH  - Angiogenesis Inhibitors
MH  - Bevacizumab
MH  - Humans
MH  - Intravitreal Injections
MH  - *Macular Degeneration/drug therapy
MH  - Ranibizumab
MH  - *Receptors, Vascular Endothelial Growth Factor
MH  - Recombinant Fusion Proteins/therapeutic use
MH  - Treatment Outcome
MH  - Visual Acuity
PMC - PMC8511619
OTO - NOTNLM
OT  - Age-related macular degeneration
OT  - Anti-VEGFs
OT  - Cost minimisation
OT  - Treat-and-extend regimen
COIS- All the authors certify that they have no affiliations with or involvement in any 
      organisation or entity with any financial interest (such as honoraria; 
      educational grants; participation in speakers' bureaus; membership, employment, 
      consultancies, stock ownership, or other equity interest; and expert testimony or 
      patent-licensing arrangements), or non-financial interest (such as personal or 
      professional relationships, affiliations, knowledge or beliefs) in the subject 
      matter or materials discussed in this manuscript.
EDAT- 2021/10/14 06:00
MHDA- 2022/03/15 06:00
PMCR- 2021/10/13
CRDT- 2021/10/13 12:26
PHST- 2021/05/06 00:00 [received]
PHST- 2021/07/27 00:00 [accepted]
PHST- 2021/07/16 00:00 [revised]
PHST- 2021/10/14 06:00 [pubmed]
PHST- 2022/03/15 06:00 [medline]
PHST- 2021/10/13 12:26 [entrez]
PHST- 2021/10/13 00:00 [pmc-release]
AID - 10.1007/s00417-021-05359-x [pii]
AID - 5359 [pii]
AID - 10.1007/s00417-021-05359-x [doi]
PST - ppublish
SO  - Graefes Arch Clin Exp Ophthalmol. 2022 Apr;260(4):1083-1095. doi: 
      10.1007/s00417-021-05359-x. Epub 2021 Oct 13.