BUDGET IMPACT ANALYSIS OF PATIENTS WITH NAMD OR DME WHO MAY REQUIRE MONTHLY DOSING WITH AFLIBERCEPT 8 MG
Author(s)
Nimesh A. Patel, MD1, Eilish Mccann, PhD2, Andreas Kuznik, PhD2, Chao Jingdong, PhD2, Xiaomeng Niu, PhD2, Disha Patel, PhD2;
1Massachusetts Eye and Ear, Boston, MA, USA, 2Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
1Massachusetts Eye and Ear, Boston, MA, USA, 2Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
OBJECTIVES: To estimate budget impact of monthly dosing with aflibercept 8 mg (8q4) based on a subset of patients who require 8q4 dosing in the PULSAR and PHOTON trials for neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME), respectively.
METHODS: In PULSAR and PHOTON, patients receiving aflibercept 8 mg every 12 (8q12) or 16 (8q16) weeks could have their dosing interval shortened to every 8 weeks (8q8) based on prespecified criteria and were evaluated for hypothetical further shortening to 8q4. A budget impact model estimated the cost to payers of aflibercept 8q4 over a 3-year time horizon. Modeling was based on the total number of reported injections for aflibercept 8q12 and 8q16 groups and the estimated number of injections for the time period that the respective eyes met hypothetical shortening criteria in PULSAR and PHOTON. Direct costs were calculated from mean number of injections and the Centers for Medicare & Medicaid Services average sales price-based payment per injection ($2491.05), plus administration costs, and reported as total cost per member per month (PMPM) for a US health plan of 1 million adults aged >40 years.
RESULTS: The proportions of eyes that would have required 8q4 dosing in PULSAR and PHOTON through 96 weeks were 10.5% and 4.8%, respectively. For nAMD, the estimated mean number of injections for eyes eligible for 8q4 in years 1 and 2 were 7.6 and 7.1, respectively. For DME, the estimated mean number of injections were 6.5 and 7.6, respectively. Implementing 8q4 dosing was estimated to result in a minimal budget increase for payers in nAMD, with $0.11 PMPM (+1.7%), and a negligible increase of $0.05 PMPM (+0.7%) in DME.
CONCLUSIONS: Modelling 8q4 dosing for a limited duration in a subset of patients estimated a minimal budget increase in nAMD and a negligible increase in DME for US payers.
METHODS: In PULSAR and PHOTON, patients receiving aflibercept 8 mg every 12 (8q12) or 16 (8q16) weeks could have their dosing interval shortened to every 8 weeks (8q8) based on prespecified criteria and were evaluated for hypothetical further shortening to 8q4. A budget impact model estimated the cost to payers of aflibercept 8q4 over a 3-year time horizon. Modeling was based on the total number of reported injections for aflibercept 8q12 and 8q16 groups and the estimated number of injections for the time period that the respective eyes met hypothetical shortening criteria in PULSAR and PHOTON. Direct costs were calculated from mean number of injections and the Centers for Medicare & Medicaid Services average sales price-based payment per injection ($2491.05), plus administration costs, and reported as total cost per member per month (PMPM) for a US health plan of 1 million adults aged >40 years.
RESULTS: The proportions of eyes that would have required 8q4 dosing in PULSAR and PHOTON through 96 weeks were 10.5% and 4.8%, respectively. For nAMD, the estimated mean number of injections for eyes eligible for 8q4 in years 1 and 2 were 7.6 and 7.1, respectively. For DME, the estimated mean number of injections were 6.5 and 7.6, respectively. Implementing 8q4 dosing was estimated to result in a minimal budget increase for payers in nAMD, with $0.11 PMPM (+1.7%), and a negligible increase of $0.05 PMPM (+0.7%) in DME.
CONCLUSIONS: Modelling 8q4 dosing for a limited duration in a subset of patients estimated a minimal budget increase in nAMD and a negligible increase in DME for US payers.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE499
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Sensory System Disorders (Ear, Eye, Dental, Skin)