{
  "abstract": "Objectives To evaluate the cost-effectiveness of anti-vascular endothelial growth factor (VEGF) treatments for neovascular age-related macular degeneration (nAMD) using a value-based model that considers drug durability, dosing regimens and real-world administration strategies, including safe vial fractionation.Design and setting Model-based pharmacoeconomic analysis using data from randomised clinical trials and network meta-analyses. Analysis conducted from the payer perspective using cost data from the Spanish National Health System.Methods A model-based analysis compared five anti-VEGF agents—innovator and biosimilar ranibizumab, aflibercept 2 mg, brolucizumab and faricimab—across three dosing regimens: fixed, Pro Re Nata and Treat-and-Extend (TAE). Administration formats included single-use vials, prefilled syringes and vial fractionation (VF), with or without dead-space-free (DSF) syringes to minimise waste. The primary outcome was cost per optimal responder, defined as a patient gaining ≥15 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, with and without adverse events. Cost-effectiveness was evaluated using Number Needed to Treat (NNT), Net Efficacy Adjusted for Risk-NNT (adjusted for safety) and incremental cost-effectiveness ratios. Secondary outcomes included the number of treated patients and optimal responders achievable within a fixed €1 000 000 budget.Results The most cost-effective strategy was aflibercept 2 mg under a TAE regimen using DSF VF, with a total cost of €6214 per patient and a cost per optimal responder of €27 155. Under a fixed budget of €1 000 000, this approach allowed treatment of 160 patients, yielding 36 optimal responders. Faricimab with DSF VF ranked second, with a total cost of €5847 and a cost per optimal responder of €28 652, treating 171 patients and achieving 34 responders. In contrast, single-use vials without VF led to substantially higher total costs (eg, €11 305 for aflibercept TAE) and lower treatment capacity (eg, 88 patients treated).Conclusions This model demonstrates that combining durable agents, extended dosing intervals and optimised delivery strategies (eg, prefilled syringes and DSF VF) can substantially improve the cost-effectiveness and sustainability of anti-VEGF therapy in public health systems.",
  "authors": [
    {
      "affiliations": [
        "PhD student in Biomedicine, Translational Research, and New Health Technologies, Department of Pharmacology and Paediatrics, Universidad de Málaga Facultad de Medicina, Málaga, Andalucía, Spain",
        "Oftalmología, Hospital Universitario Costa del Sol, Marbella, Andalucía, Spain"
      ],
      "name": "Saturnino Manuel Gismero Moreno"
    },
    {
      "affiliations": [
        "Department of Applied Economics (Statistics and Econometrics), University of Málaga, Málaga, Spain"
      ],
      "name": "Francisco Jódar Sánchez"
    },
    {
      "affiliations": [
        "IBIMA Plataforma Bionand, Universidad de Málaga Facultad de Medicina, Málaga, Spain"
      ],
      "name": "Nuria García-Agua Soler"
    },
    {
      "affiliations": [
        "RICAPPS Researcher, Research and Innovation Unit, Hospital Universitario Costa del Sol, Marbella, Spain"
      ],
      "name": "Francisco Rivas Ruiz"
    },
    {
      "affiliations": [
        "IBIMA Plataforma Bionand, Universidad de Málaga Facultad de Medicina, Málaga, Spain"
      ],
      "name": "Antonio J Garcia-Ruiz"
    }
  ],
  "title": "Model-based pharmacoeconomic analysis of anti-VEGF strategies for neovascular age-related macular degeneration: a value-based comparison of real-world administration approaches",
  "uid": "776fbf7e-4fbe-5c2b-a2d6-ac329040b367"
}