OBJECTIVES: To evaluate the budget impact of introducing ranibizumab.  METHODS: Cumulative costs were assessed using an open cohort model with a 5-year time horizon and NHS perspective. The number of eligible patients was based on: the estimated prevalence of pathologic myopia (PM) in the population >40 years old (1.2%); the incidence of choroidal neovascularization (CNV) in patients with PM (0.98%); the proportion of patients eligible for pharmacotherapy (81%) and bilateral disease prevalence (5.5%). Treatment and diagnosis rates were estimated at 80% and 83–86% respectively. Treatment frequency was based on RADIANCE trial data. The model compared two scenarios. In the ‘with ranibizumab’ scenario, the proportion of eligible patients treated with ranibizumab was estimated as 7% at year 1, increasing to 32% at year 5; the proportion receiving verteporfin photodynamic therapy (vPDT) fell  from 93% to 68%. In the ‘without ranibizumab’ scenario, only vPDT was administered. Costs of treatment, administration, monitoring, bilateral disease and management of recurrences were included. RESULTS: An estimated 2045 patients were eligible for treatment at year 1 and 2119 at year 5. In the ‘with ranibizumab’ scenario, 143 patients received ranibizumab at year 1, increasing to 678 at year 5; 1902 patients received vPDT at year 1 and 1441 at year 5. ‘With ranibizumab’ annual costs were higher in years 1–2 than ‘without ranibizumab’ costs. During years 3, 4 and 5, cost savings occurred with ranibizumab (£3867, £121 584 and £232 467, respectively), owing to lower total costs of treatment and monitoring than with vPDT. The total 5-year saving ‘with ranibizumab’ over ‘without ranibizumab’ was £227 086. CONCLUSIONS: Treating visual impairment due to CNV secondary to PM with ranibizumab rather than vPDT is estimated to provide significant cost savings in England and Wales over 5 years.