Ranibizumab Biosimilar Reduces Treatment Cost Across nAMD Subtypes

Yasuo Yanagi, MD, PhD

Credit: ResearchGate

Economic analysis of a ranibizumab biosimilar for neovascular age-related macular degeneration (nAMD) revealed its cost-saving benefit versus aflibercept across all disease subtypes from societal and patient perspectives.¹

From a societal perspective, a ranibizumab biosimilar was less costly than aflibercept, with only minor differences in quality-adjusted life-years (QALYs). Meanwhile, from the patient's perspective, a biosimilar treat-and-extend (TAE) regimen was a cost-saving alternative to other anti-vascular endothelial growth factor (VEGF) therapies.

“The results from this study can aid in optimizing cost-benefit analyses for the most preferred treatment strategies among the available options for elderly patients with nAMD from the perspectives of each stakeholder in the Japanese healthcare system,” wrote the investigative team, led by Yasuo Yanagi, MD, PhD, department of ophthalmology and micro-technology, Yokohama City University.

Anti-VEGF therapies serve as the standard of care for retinal diseases, including nAMD.² Across Asian and European countries, ranibizumab biosimilars have shown efficacy and safety similar to the reference product. Yanagi and colleagues indicated the biosimilar could be a cost-effective alternative and best supportive care (BSC) for patients with any nAMD in Japan.¹

However, cost-effectiveness analyses are few globally, and investigators noted it is crucial to take into account the patient perspective as well as the societal standpoint, in order to ensure sustained care delivery to patients with retinal diseases.

For this analysis, a Markov state-transition cohort model was designed to simulate the lifetime transition of a cohort with nAMD across health states, based on the single- versus both-eye involvement of nAMD, treatment status, and decimal best-corrected visual acuity (BCVA).

The target population comprised patients with each nAMD subtype, including typical nAMD, polypoidal choroidal vasculopathy (PCV), and retinal angiomatous proliferation (RAP). A ranibizumab biosimilar was compared against the reference product, aflibercept, aflibercept switching to ranibizumab biosimilar, and BSC, for this population.

Multiple analyses from the patient perspective focused on the TAE regimens were undertaken, including one with a cap on patient copayments and one without the cap. All costs were reported in Japanese yen (JPY) and obtained from the Japanese medical service fee schedule.

From a societal perspective, a ranibizumab biosimilar led to incremental QALYs of –0.015, 0.026, and 0.009 for typical nAMD, PCV, and RAP, respectively, compared with aflibercept. The incremental costs of JPY for the ranibizumab biosimilar versus aflibercept were JPY–50,447, JPY–997,243, and JPY –1,286,570 for typical nAMD, PCV, and RAP, respectively.

According to the patient perspective, the ranibizumab biosimilar had incremental QALYs of 0.015, 0.009, and 0.307, compared with aflibercept, aflibercept switching to a ranibizumab biosimilar, and BSC, respectively.

Incremental costs for the ranibizumab biosimilar across a patient’s lifetime, excluding the copayment cap, were estimated at JPY –138,948, JPY –391,935, JPY –209.099, and JPY –6,377,345, compared with the reference product, aflibercept, aflibercept switching to ranibizumab biosimilar, and BSC, respectively

Overall, Yanagi and colleagues pointed to the ranibizumab biosimilar as reducing medical costs for patients with nAMD, suggesting their benefit for patients with a significant financial burden from the reference products.

“As it is known that patients prefer lower medical costs for their treatments, it may be prudent to consider treatment strategies that entail switching to a less expensive biosimilar after a disease is properly observed using branded drugs during the induction phase,” they wrote.

References

1. _{Yanagi, Y., Takahashi, K., Iida, T. et al. Cost-effectiveness Analysis of Ranibizumab Biosimilar for Neovascular Age-Related Macular Degeneration and its Subtypes from the Societal and Patient Perspectives in Japan. Ophthalmol Ther (2024). https://doi.org/10.1007/s40123-024-01011-z}
2. _{Yiu G, Gulati S, Higgins V, et al. Factors Involved in Anti-VEGF Treatment Decisions for Neovascular Age-Related Macular Degeneration: Insights from Real-World Clinical Practice. Clin Ophthalmol. 2024;18:1679-1690. Published 2024 Jun 6. doi:10.2147/OPTH.S461846}