The Cost of Pressure: Quantifying the Consequences of Clinical Strain in Ophthalmology
Author(s)
Yaneth Gil Rojas, MSc1, Sebastien Eymere, MSc2, Luke Nicholson, MD3, Oliver Cox4, Marloes Bagijn, PhD5, Christian Bührer, PhD6.
1Putnam, London, United Kingdom, 2Putnam PHMR, Paris, France, 3Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom, 4RWE Lead, Roche, Basel, Switzerland, 5Hoffman La Roche AG, Basel, Switzerland, 6Roche, Basel, Switzerland.
1Putnam, London, United Kingdom, 2Putnam PHMR, Paris, France, 3Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom, 4RWE Lead, Roche, Basel, Switzerland, 5Hoffman La Roche AG, Basel, Switzerland, 6Roche, Basel, Switzerland.
OBJECTIVES: Traditional cost-effectiveness analyses typically overlook system constraints such as limited service capacity. In the context of clinic-level capacity constraints, this study assessed the costs and consequences of increasing faricimab 6 mg use compared to branded and aflibercept 2 mg biosimilar for the treatment of neovascular age-related macular degeneration (nAMD)
METHODS: A previously validated microsimulation model representing a UK National Health Service retinal outpatient service was adapted. A treatment-choice scenario compared a mix of faricimab and branded aflibercept with a new scenario featuring increased faricimab use and the switch of a proportion of patients from branded to aflibercept biosimilar. The retinal service was modelled under moderate (weekly capacity use ~93%) and severe strain (~102%). The analysis evaluated direct costs and key clinic-level performance indicators. After a 2-year initialisation period, the model projected outcomes over the subsequent 5 years.
RESULTS: Under moderate and severe strain, increased faricimab use led to substantial improvements, including reductions in out-of-hours (OoH) visits, treatment delays, and average clinic occupancy. Completion of the loading phase within 10 weeks (an important clinical indicator in this disease area) improved significantly.
Under moderate and severe strain, savings were achieved in both drug and non-drug costs. Drug cost savings primarily resulted from the moderated use of the aflibercept biosimilar, supplemented by a reduction in the frequency of visits and injections due to a decrease in faricimab-driven treatment frequency.
Normalised analyses comparing the severe versus moderate strain scenarios indicated greater per-patient reductions in treatment delays and higher per-patient service-cost savings under severe strain.
CONCLUSIONS: Innovative therapies that are more durable in clinical practice have the potential to significantly improve key clinical service indicators, reduce service pressures and mitigate litigation-related costs.
METHODS: A previously validated microsimulation model representing a UK National Health Service retinal outpatient service was adapted. A treatment-choice scenario compared a mix of faricimab and branded aflibercept with a new scenario featuring increased faricimab use and the switch of a proportion of patients from branded to aflibercept biosimilar. The retinal service was modelled under moderate (weekly capacity use ~93%) and severe strain (~102%). The analysis evaluated direct costs and key clinic-level performance indicators. After a 2-year initialisation period, the model projected outcomes over the subsequent 5 years.
RESULTS: Under moderate and severe strain, increased faricimab use led to substantial improvements, including reductions in out-of-hours (OoH) visits, treatment delays, and average clinic occupancy. Completion of the loading phase within 10 weeks (an important clinical indicator in this disease area) improved significantly.
Under moderate and severe strain, savings were achieved in both drug and non-drug costs. Drug cost savings primarily resulted from the moderated use of the aflibercept biosimilar, supplemented by a reduction in the frequency of visits and injections due to a decrease in faricimab-driven treatment frequency.
Normalised analyses comparing the severe versus moderate strain scenarios indicated greater per-patient reductions in treatment delays and higher per-patient service-cost savings under severe strain.
CONCLUSIONS: Innovative therapies that are more durable in clinical practice have the potential to significantly improve key clinical service indicators, reduce service pressures and mitigate litigation-related costs.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE690
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Health Technology Assessment
Disease
Biologics & Biosimilars, Sensory System Disorders (Ear, Eye, Dental, Skin)