Cost-Effectiveness Analysis of Anti-VEGF Agents for the Treatment of Neovascular Age-Related Macular Degeneration (AMD) in Taiwan: A Microsimulation Study

OBJECTIVES: Anti-VEGF therapy is the primary treatment for age-related macular degeneration (AMD). Compared to Ranibizumab and Aflibercept, previous CEA studies have demonstrated that off-label use of Bevacizumab is a cost-effective treatment option for AMD with the ICERs less than willingness to pay threshold in many countries but Taiwan. Considering the comparable efficacy and price difference of anti-VEGF agents in Taiwan, it is important to investigate the cost-effectiveness among all.

METHODS: Microsimulation was performed to evaluate the cost-effectiveness of three anti-VEGF agents from payer perspective in Taiwan. Real world visual acuity data from three treatments were collected to evaluate the effectiveness and QALYs. Direct costs were derived from the information provided by National Health Insurance Administration; utilities scores were derived from previous published studies; ICERs were calculated among three pairwise comparison. Three-times of GDP per capita in 2023 was used as the threshold. The time horizon was 1 year with no discounting. Sensitivity analyses were performed for the parameters uncertainty.

RESULTS: Direct cost of Aflibercept, Ranibizumab, and Bevacizumab were USD$2,372, USD$2,089, and USD$2,241 per year, respectively while the QALYs were 0.44, 0.35, and 0.38, respectively. When comparing with Ranibizumab, ICERs of Aflibercept and Bevacizumab were USD$3,018.4 and USD$4,927.0 per QALY respectively. ICER of Aflibercept compared to Bevacizumab was USD$2,077.7. One-way sensitivity analysis revealed that drug costs had the most impact on ICERs.

CONCLUSIONS: The results showed that both Aflibercept and off-label use of Bevacizumab are cost-effective compared to Ranibizumab in Taiwan. But the ICER was much higher in Bevacizumab vs Ranibizumab due to similar limited effectiveness figures for both Bevacizumab and Ranibizumab. This microsimulation using real world data may suggest a reason why Bevacizumab did not seek official approval for treating AMD reimbursement in Taiwan.