OBJECTIVES: Development of a budget analysis tool for anti-vascular endothelial growth factor (anti-VEGF) therapy considering the two main indications approved and reimbursed in Portugal: wet age-related macular degeneration (wAMD) and diabetic macular edema (DME). This calculator intends to simulate and compare the costs for each eye treated with the approved treatment options available for these indications and depending on the different regimens used – fixed, treat and extend (T&E), or pro re nata (PRN).

METHODS: For this budget analysis tool, treatment costs and monitoring costs were considered. The treatment costs included the drug costs and the administration costs; for the monitoring costs, all medical exams usually performed during a medical visit were included. Data from the Portuguese Public Health Procurement Catalog and Portaria no. 254/2018 were used to address the costs. The number of injections was based on data from published clinical studies and the monitoring visits on clinical practice.

RESULTS: Considering the listed prices of the anti-VEGF drugs, the analysis shows that, for wAMD, aflibercept has a total cost of approximately 50–60% lower than ranibizumab for the fixed and T&E regimen, which means average annual savings of 2650€ per eye treated with aflibercept. For brolucizumab in wAMD, the cost differences vary when considering the different regimens, with aflibercept allowing savings on the PRN regimen. Regarding DME, aflibercept has lower costs than ranibizumab, allowing annual savings of approximately 2800€ per eye treated in the fixed regimen.

CONCLUSIONS: This tool shows that aflibercept has significantly lower costs than ranibizumab in both indications, which translates into important savings for hospitals. Aflibercept and brolucizumab have fewer differences in terms of costs in wAMD, where the clinical evidence on efficacy and safety should also be a driver for anti-VEGF selection.