OBJECTIVES: Diabetic macular oedema (DMO) is a severe complication of uncontrolled diabetes that results in gradual visual deterioration and blindness. Since anti-vascular endothelial growth factor (VEGF) intravitreal injections interventions have widely replaced other regimens, the use of anti-VEGF intravitreal injections has resulted in a rigorous injection and follow-up schedule that is assumed to increase financial burden. The study objective is to assess the budget impact of utilizing novel anti-VEGFs (Brolucizumab and Faricimab) versus the established anti-VEGFs (Ranibizumab and Aflibercept) with the aim of estimating the previous and current economic burdens on the UK healthcare-system.

METHODS: A budget impact model, from a payer perspective, was developed to analyze the financial effects of the four anti-VEGF interventions on the DMO population in the UK. Eligible DMO population and current market shares of the four interventions were extracted from the literature. Acquisition costs were captured from the British National Formulary and NHS England (2023). The study compared direct costs exhibited by DMO patient over a time horizon of five years. The study analyzed two scenarios for the number of injections, summary of product characteristics (SMPC) scenario in line with NICE guidelines and NMA (Network-Meta analysis) scenario based on injection and monitoring visits of randomized control trials of anti-VEGfs. Study robustness was analyzed by implementing sensitivity analysis for all the inputs of the budget impact analysis.

RESULTS: While literature suggests the four anti-VEGFs have equivalent efficacy, Brolucizumab and Faricimab, requiring fewer injections, resulting in savings of £21,487,722 over five years (£405 per patient annually) in NMA scenario and £432,337,267 over five years (£8,154 per patient annually) in the SMPC scenario.

CONCLUSIONS: By assessing the potential cost savings that can be achieved by adopting novel anti-VEGFs, resource allocation can be optimized, and opportunity costs are identified throughout the decision-making process of the UK healthcare-system achieving the optimum financial efficiency.