OBJECTIVES: Faricimab is a bispecific antibody targeting Angiopoietin-2 and vascular endothelial growth factor for the treatment of diabetic macular oedema (DMO). In the YOSEMITE and RHINE trials, patients treated with a faricimab Treat & Extend (T&E) regime were compared with bimonthly (Q8W) aflibercept 2mg, with non-inferior vision gains. Recently, aflibercept 8mg has been investigated in the PHOTON trial showing non-inferior vision outcomes vs aflibercept 2mg Q8W. This research assesses the cost-effectiveness of faricimab T&E vs. aflibercept 8mg.

METHODS: A Markov cohort model was developed to estimate bilateral visual acuity changes linked to quality of life, injection frequency and associated costs from a UK societal perspective. Visual acuity changes were informed by the faricimab trials and a network meta-analysis for aflibercept 8mg. Injection frequencies were informed by the respective trials. Deterministic and probabilistic sensitivity analyses were performed for costs and key model parameters.

RESULTS: The deterministic base case resulted in a mean faricimab T&E QALY gain of 0.09 and 0.16 vs. aflibercept 8mg given every 12 weeks (Q12W) and every 16 weeks (Q16W), respectively. For the latter this translated into enabling patients to spend almost half an additional year without visual impairment. Drug and administration-related costs were higher for faricimab T&E, while costs of visual impairment and societal costs were lower, resulting overall in slightly higher total costs for faricimab. The related ICER was less than £20,000 per QALY gained vs both aflibercept 8mg regimens and therefore, well below the usually acceptable threshold by NICE. Sensitivity analyses were consistent with the base case.

CONCLUSIONS: The results indicate that faricimab might be associated with higher QALY gains and slightly higher costs compared to aflibercept 8mg. The respective ICER vs. aflibercept Q12W and Q16W were within the typically acceptable range by NICE.