OBJECTIVES: Faricimab is a bispecific antibody targeting ANG-2 and VEGF for the treatment of neovascular age-related macular degeneration (nAMD). In the TENAYA and LUCERNE trials, patients treated with individualized dosing of faricimab followed by a Treat & Extend (T&E) regime required less frequent treatments compared to Aflibercept given every eight weeks (Q8W) with non-inferior vision changes. However, clinical practice in nAMD in Canada is typically characterized by T&E regimens. This research aims to assess the cost-effectiveness of faricimab vs. anti-VEGF treatments applied in such regimens.

METHODS: A Markov cohort model was developed to estimate bilateral visual acuity linked to quality of life, injection frequency and associated costs from a Canadian payer as well as societal perspective. Transition probabilities and injection frequency were informed by the faricimab trials and a network-meta analysis. Deterministic and probabilistic sensitivity analyses were performed for costs and key model parameters.

RESULTS: The deterministic base case resulted in a mean QALY gain of 0.03, 0.05, 0.06 and 0.05 vs. ranibizumab, aflibercept, brolucizumab and bevacizumab respectively using T&E regimens. Faricimab reduced the number of injections by 37%, 21%, 28% and 46%. From a payer perspective, faricimab generated lower costs (in CAD) vs. ranibizumab, aflibercept and brolucizumab of 76,496, 29,117 and 38,235 as well as higher costs of 11,987 vs. bevacizumab. The ICER per QALY gained for the latter was 226,373 while the ICER per injection avoided was 222. From a societal perspective, faricimab was cost saving vs. bevacizumab as well. Sensitivity analyses were consistent with the base case.

CONCLUSIONS: The results indicate that faricimab is dominating ranibizumab, aflibercept and brolucizumab administered in T&E regimes that are typically used in clinical practice. From a societal perspective, it is also cost saving and therefore dominating vs. bevacizumab by cutting injection numbers and related costs in half.