Faricimab Vs. Standard of Care in Patients with Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema: A Cost-Utility Analysis in Italy

OBJECTIVES: To assess the cost-utility of faricimab vs Standard of Care (SoC) in patients with neovascular Age-Related Macular Degeneration (nAMD) and Diabetic Macular Edema (DME), from both the perspective of the Italian National Health Service (SSN) and Society.

METHODS: Two 28-day cycles Markov models were adapted to the Italian context to estimate lifetime clinical outcomes and costs of patients receiving either faricimab or SoC, considering the development of the diseases in both eyes. Health-state occupancy was estimated using data observed in faricimab non-inferiority clinical trials, assuming equal efficacy between treatments. General population mortality rates were adjusted to account for increased mortality in patients with visual disabilities. Expected survival was weighted by published utilities. The disutility associated with intravitreal injection discomfort was also considered. Direct costs included drugs acquisition and administration, while indirect costs comprised the cost of lost productivity of patients and caregivers. Resource use data and unit costs were retrieved from published literature and Italian sources.

RESULTS: Faricimab demonstrated greater efficiency compared to SoC (5.37 vs 5.35 QALYs for nAMD and 8.72 vs 8.71 QALYs for DME), due to the reduced frequency of intravitreal administrations. Considering the SSN perspective, the estimated costs for nAMD patients were €36,421 with faricimab and €68,758 with SoC (delta: €-32,338), while for DME patients the estimated costs were €33,768 and €44,269, respectively (delta: €-10,527). From a societal perspective, treatment with faricimab resulted in an incremental cost of €-37,068 and €-12,015 for nAMD and DME, respectively.

CONCLUSIONS: Faricimab was the dominant strategy compared to SoC in the treatment of both nAMD and DME, generating significant economic benefits, particularly from the societal standpoint.