Treating Geographic Atrophy Every Other Month is The More Cost-Effective Option

Credit: Massachusetts Eye and Ear

Treating geographic atrophy with intravitreal pegcetacoplan every other month is more cost-effective than every month, according to a new study presented at the 127th Annual American Academy of Ophthalmology (AAO) Congress in San Francisco, California.¹

“Although this analysis did find a modest utility preservation with treatment, the treatments are expensive,” the investigators wrote in their study.²

Pegcetacoplan may be the first FDA-approved intravitreal therapy for the treatment of geographic atrophy, but there is a need for novel utility metrics as research did not find visual improvement in the short-term.1 The investigators identified potential utility measures to compare 2 treatment methods.

The retrospective cost analysis, led by Nimesh Patel, MD, of the department of ophthalmology at Massachusetts Eye and Ear, was modeled on 2-year data from DERBY & OAKS, and the costs were based on 2022 Medicare reimbursement data. The study included no human subjects or medical records because it was exempt from institutional review board approval by the University of Miami.²

The study followed two forms of treatment—EM, where participants had treatment every month, and EOM, where participants had treatment every other month. After 2 years, the total treatment cost was $71,000 in EM and $35,000.¹

As for other costs, the cost per area of retinal pigment epithelium (RPE) in all patients was $89,000/mm2 for EM and $50,000/mm2 for EOM. The cost saved for RPE vs. sham was $8.43 with the EM treatment and $4.86 with the EOM treatment. Between the two treatments, the marginal cost saved per RPE cell was $30. Moreover, lifetime costs were either $360,000 for EM and $180,000 for EOM or $260,000/mm2 for EM and 152,000/mm2 for EOM.

Also, while 95% atrophy typically occurs in 14 years, EM delayed it by 3 years and EOM delayed it by 2.6 years. Meanwhile, the costs/quality-adjusted life sat at $660,000 for EM and $380,000 for EOM.

Ultimately, the treatment EOM—and thus treatment every other month—is the more cost-effective option for geography atrophy. Though, the investigators pointed out a couple limitations, such as cost utility studies are based on assumptions. Assumptions could include the number of injections treating CNV and the hypothetical lifetime model of geographic atrophy. The study also did not consider baseline factors like multifocal vs. single lesion nor the proximity to fovea for extrafoveal lesions.

“Treatment of extrafoveal lesions yielded greater utility than the treatment of the entire group,” the investigators wrote. “As atrophy progression approaches an upper limit, the marginal cost/benefit ratios increase.”²

References

1. ^{Nimesh A Patel, Hasenin Al-Khersan, Nicolas Yannuzzi, et al. A Cost-Effectiveness Analysis of Pegcetacoplan for the Treatment of GA. Presented at the 2023 American Academy of Ophthalmology Annual Meeting, November 3 – 6, 2023.}
2. ^{Patel NA, Al-Khersan H, Yannuzzi NA, Lin J, Smiddy WE. A Cost-Effectiveness Analysis of Pegcetacoplan for the Treatment of Geographic Atrophy [published online ahead of print, 2023 Aug 11]. Ophthalmol Retina. 2023;S2468-6530(23)00372-X. doi:10.1016/j.oret.2023.08.003}