Impact of Capacity and Resource Constraints on Wet Age-Related Macular Degeneration and Diabetic Macular Edema in the Brazilian Public Healthcare System: an Individual-Level Microsimulation Study
Author(s)
Gustavo Tiguman, PharmD, PhD1, Gabrielli Fonseca de Oliveira, BSc2, Maíra Franca Alves Martins, MD, MSc1, Jéssica Nacazume, PharmD2;
1Roche Pharma Brazil, São Paulo, Brazil, 2ValueConnected, São Paulo, Brazil
1Roche Pharma Brazil, São Paulo, Brazil, 2ValueConnected, São Paulo, Brazil
Presentation Documents
OBJECTIVES: To assess the impact of intravitreal treatments for wet Age-Related Macular Degeneration (wAMD) and Diabetic Macular Edema (DME) on care capacity and resource management of the Brazilian Public Healthcare System (SUS).
METHODS: An individual-level microsimulation model developed in Microsoft Excel assessed resource constraints on wAMD and DME treatment in a hypothetical SUS ophthalmology hospital. The model simulated 150 patients (69 wAMD and 81 DME) over 5 years, with weekly interactions between patients and the hospital. Three treatment scenarios were simulated for both diseases: faricimab, aflibercept 2 mg, and ranibizumab. Bevacizumab (off-label) was analyzed for wAMD only, as reimbursed by the Ministry of Health. Capacity constraints were represented by a limited number of available injections per week, with a specified growth rate from literature. The simulation incorporated patient characteristics, treatment intervals, hospital capacity, and delays based on national registries (DATASUS), published literature, and expert opinion, measuring hospital visits and treatment delays across all scenarios.
RESULTS: The model estimated significantly lower appointment delays for both diseases with faricimab compared with aflibercept 2 mg and ranibizumab. Over five years, faricimab resulted in 93 delays, versus 6,627 for aflibercept 2 mg and 9,305 for ranibizumab, representing a 99% delay reduction. Faricimab required fewer hospital visits due to longer injection intervals: 3,648 visits compared with 4,160 for both aflibercept 2 mg and ranibizumab. Considering wAMD only, faricimab showed the lowest number of visits (1,448) and delays (78) compared with 1,797 and 714 for aflibercept 2 mg, 1,820 and 3,948 for ranibizumab, and 1,820 and 7,702 for bevacizumab, respectively.
CONCLUSIONS: Faricimab, with longer injection intervals, significantly reduces hospital visits and treatment delays for wAMD and DME compared with aflibercept 2 mg, ranibizumab, and bevacizumab in the Brazilian Public Healthcare System. This reduction eases the burden on SUS, enhancing the system’s efficiency and patient care.
METHODS: An individual-level microsimulation model developed in Microsoft Excel assessed resource constraints on wAMD and DME treatment in a hypothetical SUS ophthalmology hospital. The model simulated 150 patients (69 wAMD and 81 DME) over 5 years, with weekly interactions between patients and the hospital. Three treatment scenarios were simulated for both diseases: faricimab, aflibercept 2 mg, and ranibizumab. Bevacizumab (off-label) was analyzed for wAMD only, as reimbursed by the Ministry of Health. Capacity constraints were represented by a limited number of available injections per week, with a specified growth rate from literature. The simulation incorporated patient characteristics, treatment intervals, hospital capacity, and delays based on national registries (DATASUS), published literature, and expert opinion, measuring hospital visits and treatment delays across all scenarios.
RESULTS: The model estimated significantly lower appointment delays for both diseases with faricimab compared with aflibercept 2 mg and ranibizumab. Over five years, faricimab resulted in 93 delays, versus 6,627 for aflibercept 2 mg and 9,305 for ranibizumab, representing a 99% delay reduction. Faricimab required fewer hospital visits due to longer injection intervals: 3,648 visits compared with 4,160 for both aflibercept 2 mg and ranibizumab. Considering wAMD only, faricimab showed the lowest number of visits (1,448) and delays (78) compared with 1,797 and 714 for aflibercept 2 mg, 1,820 and 3,948 for ranibizumab, and 1,820 and 7,702 for bevacizumab, respectively.
CONCLUSIONS: Faricimab, with longer injection intervals, significantly reduces hospital visits and treatment delays for wAMD and DME compared with aflibercept 2 mg, ranibizumab, and bevacizumab in the Brazilian Public Healthcare System. This reduction eases the burden on SUS, enhancing the system’s efficiency and patient care.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE354
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Novel & Social Elements of Value
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Sensory System Disorders (Ear, Eye, Dental, Skin)