Cost-effectiveness of biosimilar ranibizumab versus originator ranibizumab for neovascular age-related macular degeneration in the Republic of Korea

Abstract Neovascular age-related macular degeneration (nAMD) requires long-term anti-VEGF therapy that imposes substantial direct payer costs. LucenBS (CKD-701), the first domestic ranibizumab biosimilar in Korea, was listed under the 2024 HIRA tariff at 149,895 KRW per vial, a 74% discount versus originator ranibizumab (Lucentis; 576,879 KRW). We built a 5-state Markov cohort model stratified by best-corrected visual acuity over a 10-year horizon from the Korean payer perspective, applying identical transition probabilities, utilities and injection frequencies to both arms based on the pivotal phase 3 equivalence trial. Because efficacy was assumed equivalent, the incremental comparison is effectively a cost-minimization on discounted, survival-weighted injection exposure multiplied by the price differential; the Markov structure provided absolute costs, quality-adjusted life-years (QALYs) and threshold analyses. Costs and QALYs were discounted at 4.5% per year (1 USD = 1350 KRW). Switching from originator to biosimilar saved $8953 per patient (from $26,095 to $17,142; $8.95 million per 1000 patients) with identical 4.7223 QALYs, making the biosimilar cost-minimizing. Probabilistic analysis showed 100% probability of cost saving. The biosimilar would remain cost-effective unless its effectiveness were at least 0.24 QALYs (about 5%) lower over 10 years. The result is driven by price, not by any clinical difference.