OBJECTIVES: Study the current utilization of anti-VEGFs in ophthalmology and the impact of biosimilar entry in Europe and North America to date and for the future.

METHODS: Molecule utilization is measured by treatment days (TD) per capita (i.e., treatment rate). TD and sales information are primarily based on IQVIA Analytics Link proprietary data, complemented with company financial statements where data gaps existed. Aflibercept, brolucizumab, faricimab, and ranibizumab with primarily approved ophthalmic indications are included. Ranibizumab has biosimilars on market already, while the other 3 are expected to face biosimilar competition in the coming years. Separate desk research on the availability of ranibizumab biosimilars was performed in the investigated markets.

RESULTS: From 2018-2022, total annual TD of the 4 investigated molecules has increased by 54%. The 3 countries with highest treatment rates have an average of 0.974 TD/capita; the 3 countries with lowest treatment rates have 0.005 TD/capita, indicating a 190-fold difference.

The average annual drug sales by value (based on list or average invoice price, depending on country, which do not take into account rebates or clawbacks and therefore do not reflect net prices realized by manufacturers) for the treatment with reference products of all 4 molecules across the 30 markets is estimated at 11.6 billion USD. Assuming a typical biosimilar discount rate of 30%-60%, the annual savings potential is estimated at 3.5-7.0 billion USD.

As per October 1^st 2023, 19 out of 30 studied countries have ranibizumab biosimilars list price available.

CONCLUSIONS: The usage of established and newer anti-VEGFs has increased significantly in the past 5 years and will likely increase further due to aging population. Biosimilars could offer a more cost-effective treatment option and significant savings.

Yet, in 30% of the examined countries there is little evidence of ranibizumab biosimilars to date, presumably due to unfavorable market conditions.