The anti-vascular endothelial growth factor drugs ranibizumab and aflibercept, used to treat vision loss from diabetic macular edema (DME), and approximately 20 to 30 times more expensive than bevacizumab, are not cost-effective for treatment of DME compared to bevacizumab unless their prices decrease substantially, according to a study published online by JAMA Ophthalmology.
Anti-vascular endothelial growth factor (VEGF) medicines have revolutionized DME treatment. A recent randomized clinical trial comparing anti-VEGF agents for patients with decreased vision from DME found that at 1 year aflibercept (2.0 mg) achieved better visual outcomes than repackaged (compounded) bevacizumab (1.25 mg) or ranibizumab (0.3 mg); the worse the starting vision, the greater the treatment benefit with aflibercept.
These agents also vary substantially in cost. On the basis of 2015 costs, aflibercept was $1,850, ranibizumab, $1,170, and repackaged (compounded) bevacizumab, approximately $60 per dose. Considering that these medicines may be given 9 to 11 times in the first year of treatment and, on average, 17 times during 5 years, total costs can be substantial. In 2010, when these intravitreous agents were being used predominantly for age-related macular degeneration, ophthalmologic use of VEGF therapy cost approximately $2 billion or one-sixth of the entire Medicare Part B drug budget. In 2013, Medicare Part B expenditures for aflibercept and ranibizumab alone totaled $2.5 billion.
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