Presentation (CTI)

OBJECTIVES: Diabetic macular edema imposes substantial clinical burden. Frequent anti-vascular endothelial growth factor injections required for standard management generate substantial healthcare resource utilization and treatment burden. Consequently, an unmet need exists for more durable treatments. This study evaluated the clinical and economic value of faricimab to assess its relevance to Kazakhstan.
METHODS: A systematic literature review using the PICOS framework evaluated evidence from PubMed, the Cochrane Library, ClinicalTrials.gov, and health technology assessment agencies. Clinical parameters informed a locally adapted Markov model comparing faricimab against standard therapies, specifically aflibercept and ranibizumab. The model utilized best-corrected visual acuity-based health states with four-week cycles over a lifetime horizon from a public healthcare payer perspective. Health outcomes were measured in quality-adjusted life-years (QALYs). A cost-effectiveness analysis and five-year budget impact analysis were conducted.
RESULTS: Trials demonstrated faricimab maintained noninferior best-corrected visual acuity outcomes compared to aflibercept, while providing greater central subfield thickness reduction and higher complete retinal fluid resolution rates. Real-world evidence findings confirmed clinical trial durability; over 73% of patients achieved ≥12-week intervals, and over 52% maintained 16-week intervals. Safety profiles were comparable to standard therapies. Economically, faricimab yielded incremental gains of 0.08 QALYs versus aflibercept and 0.11 QALYs versus ranibizumab. Faricimab was associated with lower total costs, resulting in incremental savings of approximately $4,111 and $1,333 per patient, respectively. This dominance resulted in cost-saving incremental cost-effectiveness ratios. The prolonged duration of action reduced injection frequency, contributing to treatment burden and healthcare resource utilization reductions. The five-year budget impact analysis projected cost offsets yielding approximately $14.55 million in cumulative savings.
CONCLUSIONS: Faricimab represents a dominant therapeutic strategy for managing diabetic macular edema. The extended administration intervals may reduce treatment burden, lower healthcare resource utilization, and provide significant cost offsets. These findings may improve ophthalmology service efficiency and inform reimbursement decision-making.