A Comparison of Time-Driven Activity-Based Costs for Patients and Caregivers Receiving Intravitreal Treatments for Neovascular Age-Related Macular Degeneration

OBJECTIVES: Neovascular age-related macular degeneration (nAMD) is the leading cause of vision loss and a chronic condition. Treatment requires frequent intravitreal (IVT) injections, which place a significant burden on patients and caregivers. Each IVT therapy has a unique, patient-specific dosing regimen and maintenance injection frequencies can vary from every (q) 4 to 16 weeks. This study sought to quantify the total financial burden, including drug cost and time lost (e.g., to travel), for patients and caregivers for four IVT nAMD therapies and their approved dosing frequencies.

METHODS: To complete this Canadian time-driven activity-based costing (TDABC) study, a patient journey was constructed to capture direct and indirect activities related to nAMD treatment, over three years. Activities were quantified using data from publicly available sources. Lost productivity for patients and their caregivers, financial burden of treatment, and ancillary costs (e.g., transportation, meals, daily support) were all included. Costs associated with adverse events were excluded. IVT treatments aflibercept, bevacizumab, faricimab, and ranibizumab visit frequencies were considered within the modeled journey according to their Health Canada approved dosing regimen(s). Preliminary findings were validated by a patient advocacy group.

RESULTS: Of the dosing regimens requiring 21 visits over three years, bevacizumab was the least costly in terms of total burden ($47,555) compared to aflibercept or ranibizumab ($70,655 each). Faricimab administered at a maintenance interval of q16 weeks (13 visits in 3 years) had the lowest total burden ($40,242) of all the drugs and regimens tested.

CONCLUSIONS: The frequency of IVT injections combined with drug costs impact the total burden experienced by patients with nAMD and their caregivers. Of the four IVT treatments and seven regimens studied, faricimab dosed at a maintenance interval of 16 weeks was the least burdensome to patients and their caregivers managing nAMD.