Presentation (CTI)

OBJECTIVES: Budget impact models (BIMs) project drug demand but rarely account for local operational constraints. This study utilised a novel clinical backlog impact model (CBIM) to demonstrate the direct link between longer treatment durability and clinic capacity benefits, evaluating first-line faricimab versus first-line aflibercept 2mg (including partial switch to faricimab for sub-optimally managed patients) in neovascular age-related macular degeneration (nAMD).
METHODS: A deterministic cohort model projected service demand over a 5-year horizon (2026/27-2030/31) for an incident cohort of 200 nAMD patients annually (10% annual growth). Injection frequencies aligned with NICE TA800 guidelines. A 50% switching rate from aflibercept to faricimab for inadequate responders was applied based on the PRECISE study. The CBIM overlayed a fixed injection capacity constraint, baselined on the prior year's delivered injections. To isolate treatment selection impact, capacity breaches and subsequent backlogs accumulate strictly within this incident cohort. Beyond-capacity injections translate 1:1 to delayed patient appointments.
RESULTS: Over 5 years, the faricimab 1L scenario required 12,527 injections compared to 16,222 for the aflibercept 2mg 1L including partial switch to faricimab scenario. Under fixed capacity limits, the faricimab 1L scenario successfully absorbed demand, resulting in just 4 injections falling beyond capacity and a negligible End-of-Year (EoY) backlog of 3 delayed patients by Year 5. In contrast, the aflibercept 2mg 1L scenario including partial switch to faricimab generated 2,702 beyond-capacity injections, creating a compounding backlog leaving 244 patients delayed at Year 5.
CONCLUSIONS: The CBIM effectively illustrates how extended treatment durability relieves systemic pressure. Notably, this model represents a conservative estimate, as it does not factor in the clinical penalty of delayed treatments, which would likely necessitate shortened intervals and exacerbate capacity strain. Ultimately, choosing longer-acting agents like faricimab minimises capacity breaches and prevents compounding patient backlogs.