Budget Impact Analysis of Faricimab for treating patients with Diabetes Macular Edema or Neovascular Age-Related Macular Degeneration in Costa Rica

OBJECTIVES: Diabetic Macular Edema (DME) and neovascular Age-related Macular Degeneration (nAMD) cause vision loss leading to loss of health-related quality of life. Faricimab is a bispecific antibody that binds and inhibits both VEGF-A and angiopoietin-2. The aim is to estimate the budget impact (BI) of using Faricimab in Costa Rica's healthcare system.

METHODS: A BI model estimated the change in expenditure over a three-year time horizon for treating patients with DME or nAMD in Costa Rica, assuming the cohort increases by 3% of new patients annually with Faricimab. The comparators are standard of care (SoC) (88% first year) and aflibercept (12% first year). Patients eligible to treat DME are 12,232 (48% have bilateral disease) and 1,234 for nAMD (36% have bilateral disease). Patients with DME treated with Faricimab receive 8.4 intravitreal injections on first year and 4.9 after the second year; 9.4 and 5.0 with Aflibercept; and 9.9 and 5.5 with SoC. Patients with nAMD treated with Faricimab receive 6.79 intravitreal injections annually and 4.69 after the second year; 8.0 and 5.63 with Aflibercept; and 10.06 and 8.44 with SoC. Surgery room costs are $882 for every intravitreal injection; ambulance costs for patients who live out of San José are $486; outpatient visits cost $98, and OCT scans cost $37. Costa Rican advisory board estimated direct and indirect healthcare costs.

RESULTS: First year's BI is -$188,774; second year is -$380,802; third-year BI is -$575,929; and 3-year total BI is -$1,145,505. Patients with DME treated with Faricimab during first-year are 370, 747 second-year, and 1,130 third-year. In addition, 37 patients with nAMD received Faricimab first year, 75 second year, and 114 third year.

CONCLUSIONS: Faricimab saves money for Costa Rican system health from the first-year because it needs fewer intravitreal injections and reduces using the operating room, ambulance, and patient follow-up.