Ravi Parikh, MD, MPH: Anti-VEGF Biosimilar Paradox in Ophthalmology

The ophthalmology sector may potentially face a cost increase following the approval of an anti-vascular endothelial growth factor (anti-VEGF) biosimilar, according to new research.

The analysis, presented at the 2023 Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting, suggests the approval of an intraocular bevacizumab (Avastin®) biosimilar (bevacizumab-vikg) would lead to a drastic increase in costs, suggesting the greater need to keep intravitreal injections accessible to all patients.

“What we found was this strange rule, even if all of ranibizumab (LUCENTIS) and aflibercept (EYLEA) currently being used was switched over to a theoretical biosimilar based on current biosimilar prices, that still wouldn’t offset the 5-10x increase in cost for bevacizumab,” Ravi Parikh, MD, Clinical Assistant Professor, Department of Ophthalmology, NYU Grossman School of Medicine told HCPLive. “That is really concerning because that would really limit access and create a huge amount of burden on both payers and patients.”

Anti-VEGF medications are the standard of care for many retinal diseases but often have a significant and increasing cost on healthcare and patients. Thus, Parikh and colleagues suggest the use of biosimilars may be a way to help reduce these costs. However, the analysis indicated the impending approval of an ophthalmic biosimilar formulation of bevacizumab may paradoxically increase the cost burden of anti-VEGF agents.

The approval of a biosimilar formulation may mean “off-label” compounded drugs may no longer be an option for patients. Parikh and colleagues set out to investigate the impact of biosimilars on healthcare systems and patient costs in the US. All data used in their analysis was publicly available Medicare data and previously published market share data.

Investigators calculated the average sale price (ASP) of ranibizumab, aflibercept, and bevacizumab from Medicare allowable payments and a previously published representative Medicare administrative contractor allowable. Meanwhile, the ASPs of biosimilars are calculated from wholesale acquisition costs from a representative distributor. The cost for an intraocular bevacizumab formulation is modeled at $500 and $900 per injection, an increase from $84.91 per injection with current off-label use.

Upon analysis, investigators found a price of $500 for intraocular bevacizumab, costs to Medicare would increase by $457 million from $3.01 billion to $3.47 billion, or an increase of 15.2%. The patient responsibility would increase by $117 million from $768 million to $884 million.

Likewise, if intraocular bevacizumab were priced at $900, the analysis suggested Medicare costs would increase by $897 million to $3.91 billion (an increase of 29.8%), and patient responsibility would increase by $229 million to $997 million. Parikh and colleagues suggested that, theoretically, the use of ranibizumab and aflibercept biosimilars may offset the increased cost of bevacizumab, reducing overall costs.

However, if the price of bevacizumab were to increase to $500, the team suggested switching all patients currently on ranibizumab or aflibercept to respective biosimilars would compensate for only 28.1% of the increased cost.

Watch the above interview with Ravi Parikh, MD, MPH to learn more from the analysis. Parikh reports no relevant disclosures.

References

Zhang C, Friedman S, Mruthyunjaya P, Parikh R. The Biosimilar Paradox: How Anti-VEGF Biosimilars Will Increase Patient and Overall Healthcare Costs. Presented at the 2023 Association for Research in Vision and Ophthalmology Annual Meeting; April 2023; New Orleans, LA.