Distance, time of travel contribute to holistic cost of anti-VEGF therapy
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Longer acting anti-VEGF therapies that require fewer injections and clinic visits may provide greater cost-saving benefit for patients with age-related macular degeneration, according to a study in Clinical Ophthalmology.
“Longer acting anti-VEGF therapies may differ not only in their wholesale acquisition cost, but also in the frequency of per label injections and associated clinic visits,” Elana A. Meer, MD, MBA, a resident in ophthalmology at the University of California, San Francisco, and colleagues wrote. “Taking into account distance and time cost of travel may contribute to a more holistic view of cost differences among these therapies.”
To determine how travel time and distance contribute to the comprehensive cost of longer acting anti-VEGF therapy for the treatment of AMD, Meer and colleagues performed a theoretical cost-saving analysis using publicly available pricing data on the first 3 years of faricimab, ranibizumab and aflibercept therapy, as well as transportation costs from the Veteran Affairs Medical Center.
Researchers found that the price differential between treatments grows as the distance of travel increases: Ranibizumab was $38,814 more expensive than faricimab when a patient travels 25 miles for treatment, compared with $37,709 more expensive without travel.
Further, ranibizumab was $31,350 more than aflibercept without travel and $32,133 more with a distance of 25 miles to a clinic, while aflibercept was $6,359 more expensive than faricimab without travel and $6,681 more expensive with a distance of 25 miles to a clinic.
The price differentials continued to grow as the distance to treatment increased from 25 miles to 50, 100 and 200 miles, according to researchers.
“We demonstrate that when taking into account distance and time cost of travel, longer duration therapies for macular degeneration may have even greater cost benefits than previously thought due to a reduction in frequency of injections and clinic visits,” Meer and colleagues wrote. “We hope this work drives further considerations surrounding incorporating travel costs into cost-benefit analyses for longer acting therapies.”
Perspective
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While anti-VEGF therapy is crucial to minimize vision loss from neovascular AMD, it can certainly cause a financial burden on patients and their families. Patients with AMD tend to be of retiring age but yet can face costs close to $2,000 per injection depending on insurance and therapy. The amount of time and travel required by patients and their caregivers for these clinic visits come at a financial cost as well.
Clinical studies have suggested similar visual outcomes among three FDA-approved anti-VEGF monotherapies, which range in dosing from 12 injections a year to as little as five.
If that’s the case, optometrists comanaging with ophthalmologists should consider cost-effective therapies that require less frequent clinic visits and injections, such as FDA-approved faricimab. Bevacizumab, while off label, has also been shown to successfully manage neovascular AMD for a fraction of the cost. When possible, these choices could save thousands of dollars for our patients over the course of their long-term treatment.
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