Cost-Effectiveness of Faricimab in Patients With Diabetic Macular Edema in Canada

OBJECTIVES: Faricimab is a bispecific antibody targeting ANG-2 and VEGF for the treatment of diabetic macular edema (DME). In the YOSEMITE and RHINE trials, patients treated with faricimab in a Treat & Extend (T&E) regime required less frequent treatments compared to Aflibercept given every eight weeks (Q8W) with non-inferior vision changes. However, clinical practice in DME in Canada is typically characterized by pro re nata (PRN) regimens as well as T&E. This research aims to assess the cost-effectiveness of faricimab vs. anti-VEGF treatments applied in such regimens.

METHODS: A Markov cohort model was developed to estimate bilateral visual acuity changes linked to quality of life, injection frequency and associated costs from a Canadian payer as well as a societal perspective. Transition probabilities and injection frequency were informed by the faricimab trials and a network-meta analysis. Deterministic and probabilistic sensitivity analyses were performed for costs and key model parameters.

RESULTS: The deterministic base case resulted in a mean QALY gain of 0.48, 0.21 and 0.53 vs. ranibizumab, aflibercept and bevacizumab respectively using PRN regimens and 0.55 vs. ranibizumab using a T&E regimen. From a payer perspective, faricimab generated lower costs (CAD) vs. ranibizumab (PRN & T&E) and aflibercept of 22,031, 20,600 and 8,480 as well as higher costs of 31,019 vs. bevacizumab enabling patients to spend more than 1.5 additional years without visual impairment. The ICER for the latter from a payer and societal perspective was 58,637 and 33,516. Faricimab was also associated with a better durability profile than current treatment options. Sensitivity analyses were consistent with the base case.

CONCLUSIONS: The results indicate that faricimab is dominating ranibizumab and aflibercept administered in flexible regimens typically used in clinical practice. It is associated with an ICER vs. bevacizumab that is within the typically acceptable range especially from a societal perspective.