Objectives: Monthly dosing with ranibizumab (RBZ) is needed to achieve maximal sustained visual gains in patients with neovascular (“wet”) age-related macular degeneration (wAMD). In Sweden dosing is on an as-needed (PRN) basis, resulting in suboptimal efficacy. IVT-AFL dosed every 2 months (IVT-AFL Q8) demonstrated clinically equivalent efficacy compared to RBZ monthly dosing (RBZ Q4) in a randomi-zed clinical trial setting. We assessed the cost-effectiveness of IVT-AFL Q8 vs. RBZ Q4 and RBZ PRN real-life data, in a Swedish setting. Methods: A Markov model compared wAMD treatment over two years with either IVT-AFL, RBZ Q4, or real-life RBZ PRN. Health states were based on visual acuity in the better-seeing eye; a proportion discontinued treatment monthly or upon visual acuity <20/400. Parameters were estimated from trial data, published literature, or expert opinion. Analyses were performed from a societal perspective with a lifetime horizon (starting age 77 years). The model calculated costs (drug, administration, monitoring, vision impairment, adverse events, caregiver), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs), all discounted 3% annually. Deterministic and probabilistic sensitivity analyses were performed. Results: IVT-AFL cost 578,400 SEK, compared with 686,600 SEK for RBZ Q4 and 573,600 SEK for real-life RBZ PRN; QALYs totaled 4.58 for IVT-AFL, 4.59 for RBZ Q4, and 4.41 for real-life RBZ PRN. Compared with real-life RBZ PRN, IVT-AFL cost 26,700 SEK/QALY gained. RBZ Q4 cost over 20 million SEK/QALY gained compared with IVT-AFL Q8. The model was most sensitive to IVT-AFL efficacy and patient age. IVT-AFL had a 42% probability of dominating RBZ Q4 and a 100% probability of being cost-effective vs. RBZ PRN at an assumed willingness-to-pay threshold of 500,000 SEK. Conclusion: Results suggest that, in Sweden, attainment of maximal visual gains via IVT-AFL is cost-effective compared with real-life RBZ PRN dosing. RBZ Q4 is not cost-effective relative to IVT-AFL.