The Financial Impact of Antivascular Endothelial Growth Factor Drug Durability

Purpose: To examine the yearly cost of antivascular endothelial growth factor (anti-VEGF) therapy borne by patients and to assess the major contributors to patient cost. Methods: A retrospective, cross-sectional cost analysis was conducted of 29 250 insured patients in a single practice receiving anti-VEGF injections over a 21-month period between January 1, 2023, and September 30, 2024. Direct costs to the patient were abstracted, including patient copay and patient-responsible portions of imaging, medication, procedure, and visit costs; medication costs were based on average sales price. Transportation cost and opportunity cost associated with missed work were operationalized to estimate indirect costs, using age-stratified employment rates and median earnings from the United States Bureau of Labor Statistics for both patients and accompanying caregivers. Results: The mean (±SD) direct cost per visit was $91.72 ± $22.22. Indirect costs per visit varied by indication, with a mean indirect cost per visit of $97.89 for patients with neovascular age-related macular degeneration (AMD) and $164.44 for patients with diabetic macular edema (DME) for a half day of missed work, and $167.98 and $301.09, respectively, for a full day off work. Indirect costs accounted for 45.37% to 74.86% of total patient cost for a half day off, and 58.76% to 84.50% for a full day off. Relative to the baseline of 12 monthly bevacizumab injections received annually (half-day off scenario), the equivalent total patient cost accrued would correspond to a mean annual number of injections of 9.32 and 10.00 for aflibercept 2 mg, 11.09 and 11.35 for aflibercept 8 mg, and 9.05 and 9.78 for faricimab 6 mg in patients with neovascular AMD and patients with DME, respectively. Conclusions: Patient cost is driven more by visit frequency and its associated indirect costs than by drug price. Less frequent dosing with a more durable agent can therefore lower the total cost experienced by patients despite a higher acquisition price.