OBJECTIVES: Faricimab is a bispecific antibody targeting Angiopoietin-2 and vascular endothelial growth factor for the treatment of neovascular age-related macular degeneration (nAMD). In the TENAYA & LUCERNE trials, patients were treated with individualized dosing of faricimab followed by a Treat & Extend (T&E) regime reflecting common clinical practice. Recently, aflibercept 8mg has been investigated in the CANDELA as well as the PULSAR trial, where the latter applied less stringent disease activity criteria than commonly used in clinical practice to determine patient's ability to extend treatment intervals after the loading period. This research aims to assess the costs of faricimab vs. aflibercept 8mg simulating the use of more comparable disease activity criteria.

METHODS: A Markov cohort model was developed to estimate bilateral visual acuity linked to life expectancy, injection frequency and associated costs from a UK healthcare system perspective. The base case was informed by the interval distribution in TENAYA & LUCERNE for faricimab and the CANDELA trial for aflibercept 8mg since the study used a more comparable definition of disease activity. Deterministic sensitivity analyses were performed for costs and key model parameters. In a scenario analysis, interval distributions were informed by PULSAR for aflibercept 8mg and TENAYA & LUCERNE for faricimab simulating the disease activity criteria from PULSAR.

RESULTS: The deterministic base case resulted in faricimab being associated with lower costs compared to aflibercept 8mg. Injection frequency was slightly less for faricimab. The scenario analysis applying the disease activity criteria from PULSAR consistently resulted in faricimab being associated with lower costs and slightly less injections. Sensitivity analyses were consistent with the base case.

CONCLUSIONS: The results indicate that faricimab might be cost-saving compared to aflibercept 8mg when simulating treatment regimens reflecting common clinical practice. The analysis highlighted the relevance of the criteria being used to evaluate disease activity and, consequently, treatment intervals.