OBJECTIVES: Chronic diseases and aging are rising in Peru, demanding further resources for treatments to both patients and the public health system. These two trends are linked with diseases like diabetic macular edema (DME) and age-related macular degeneration (AMD). DME is related to diabetes, a disease that affects 1.3 million adults aged 20 to 79, with around 40% remaining undiagnosed. On the other hand, wet AMD leads vision loss, accounting for 12% of cases of blindness in Peru. Within this framework, this research aims to determine which of the treatment schemes (faricimab, bevacizumab, aflibercept and ranibizumab) for DME and AMD is most cost effective in Peru (EsSalud).

METHODS: Annual direct and indirect treatment costs were evaluated using local data such as clinical guidelines and Peruvian databases (ENAHO, HISMINSA, EsSalud Tariff Scheme, etc) to identify resource utilizations and unit costs in Peru. Furthermore, a meta-analysis was conducted, compiling 80 studies that compare the effectiveness of various treatment schemes.

RESULTS: Faricimab is the least expensive treatment scheme because its application often occurs every 16 weeks (the longest period across the alternatives). Consequently, it provides savings of US$ 2,823 (51% for the payer) throughout the treatment compared to bevacizumab. Notwithstanding the above, narrowing down the analysis only to the first year, in which faricimab requires extra loading doses, faricimab proves to be cost saving against aflibercept and cost-effective against bevacizumab considering its 4.6% greater effectiveness.

CONCLUSIONS: Faricimab demonstrates consistent savings and superior efficacy throughout the treatment. This conclusion holds for each year of analysis when comparing to aflibercept. Nevertheless, because of loading doses, in the case of bevacizumab savings for the system become apparent from the ninth year onwards. Overall, we estimate that a progressive transition of 871 patients from bevacizumab to faricimab results in savings of US$ 91 per patient.