Cost-effectiveness analysis of Brolucizumab compared to Aflibercept and Ranibizumab in nAMD with persistent retinal fluid

Purpose of the researchThis study aimed to evaluate the cost-effectiveness of Brolucizumab in patients with exudative age-related macular degeneration (AMD) and persistent retinal fluid unresponsive to previous therapies, within the context of a real-world clinical practice setting in a Spanish referral hospital. Furthermore, the study examined the probabilities of transitioning between therapies.Major findingsA 6-month treatment projection demonstrated that Brolucizumab was not cost-effective compared to Ranibizumab (incremental cost-effectiveness ratio [ICER]: -12.98) and Aflibercept (ICER: -47.64). Conversely, when assessing only drug and administration visit costs, Brolucizumab appeared cost-effective (ICER of 9.14 versus Aflibercept and 35.01 versus Ranibizumab). The increased burden of follow-up costs, which were €348.96 higher than those for Ranibizumab and €174.48 higher than Aflibercept, likely drove the trend towards non-cost-effectiveness. Additionally, the analysis indicated a 43% probability of transitioning to Faricimab within the studied population.ConclusionsBrolucizumab was determined to be not cost-effective compared to Ranibizumab and Aflibercept in patients with exudative AMD and persistent retinal fluid, primarily due to a higher number of follow-up visits necessitated by its safety profile. Furthermore, newly observed vitreous opacities and a tendency towards the use of Faricimab were noted.