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  • Cost Utility of Bevacizumab Versus Aflibercept for RVO-Related Macular Edema

    By Lynda Seminara
    Selected and reviewed by Neil M. Bressler, MD, and Deputy Editors
    Retina/Vitreous
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    Journal Highlights

    JAMA Ophthalmology, June 2023

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    Using a Markov process and a micro­simulation cohort of patients with char­acteristics similar to those of SCORE2 participants, Kymes et al. conducted a cost-utility comparison of bevacizumab and aflibercept for treatment of macu­lar edema (ME) caused by retinal vein occlusion (RVO). For the first year of treatment, they found that the costs of aflibercept exceeded those of bevacizumab by more than $18,000.

    The simulated cohort included 5,000 patients who were evaluated 100 times, each with a different set of demograph­ic and clinical characteristics, which were selected randomly and were based on the SCORE2 trial. Cohort members had a diagnosis of ME caused by cen­tral or hemiretinal RVO. The authors chose utility as the quality-of-life para- meter because of its value in quantify­ing patients’ perceptions of the impor­tance of functional limitations. Data were collected for a five-year period (through October 2019) and were analyzed subsequently. Incremental cost-utility data were compared for bevacizumab and aflibercept, each as first-line treatment.

    According to the analysis, the cost of treatment for the first year was $18,127 higher with aflibercept. For the same period, the gain in quality-adjusted life-years was .026 with bevacizumab and .020 with aflibercept. Given these findings and the similar clinical efficacy of the two drugs, bevacizumab appeared to have superior cost utility. At the current prices, aflibercept would be considered more cost-effective than bevacizumab only if it could achieve nearly perfect vision for the patient.

    The authors acknowledged that some patients with RVO-related ME may derive a greater benefit from initial treatment with aflibercept as opposed to bevacizumab. To better understand the optimal use of these drugs for this condition, the authors suggest includ­ing anatomic as well as patient-centered outcomes in future research. (Also see related commentary by Sean T. Berkow­itz, MD, MBA, and Avni P. Finn, MD, MBA, in the same issue.)

    The original article can be found here.