PSS5 Bevacizumab Versus Ranibizumab for Age-Related Macular Degeneration (AMD): A Budget Impact Analysis

Abstract

The use of intravitreal injection of vascular endothelial growth factor inhibitors is an effective treatment for AMD and trials have showed similar clinical effects of bevacizumab and ranibizumab. The aim of this study was to estimate the budget impact for Brazilian Ministry of Health (MoH) recommending ranibizumab instead of bevacizumab for AMD. We did a deterministic budget impact analysis, with the MoH perspective, comparing the use of ranibizumab and bevacizumab for wet AMD. The target population was estimated by extrapolating epidemiologic data to the Brazilian population. Data about dosage, administration and fractioning were extracted from literature. Prices were obtained with the Brazilian regulatory agency, applying potential discounting benefits. This analysis did not consider the cost of the fractioning process because it will be assumed by the states and not by the MoH. The considered price of the ranibizumab vial was US$ 962.86 (fractioning is not an option). In contrast, a 4 mL vial of bevacizumab would cost US$ 410.86 (US$ 5.14 each 0.05 mL dose, resulting in 80 doses/vial). Therefore, the expenses of one year on ranibizumab would be about US$ 11,554.37 and about US$ 61.63 for bevacizumab (12 injections for both). Thus, the use of ranibizumab instead of bevacizumab for treating 467,600 people would be related with a US$ 5,374,007,960.48 budget impact. The sensitivity analyses also demonstrated a budget impact of US$ 3,097,416,007.65 and US$ 5,287,555,101.51 (1 dose/vial and 20 doses/vial, respectively). Although not a label indication, bevacizumab has been widely adopted in clinical practice. As presented above, even with inefficient fractioning methods, the use of bevacizumab would bring substantial savings to MoH resources. Even the need of preserving the sterility of the solution being a real-world worry, stability studies have showed the maintenance of the solution characteristics through adequate handling and storage.