OBJECTIVES Ranibizumab has demonstrated efficacy in patients with myopic choroidal neovascularization (mCNV) and is the first anti-VEGF licensed in this indication. Aflibercept is being evaluated for use in mCNV. An existing model demonstrating the cost-effectiveness of ranibizumab versus verteporfin photodynamic therapy was adapted to provide an initial evaluation of ranibizumab versus aflibercept. METHODS A Markov model in mCNV with a lifetime horizon and visual acuity health states was adapted to evaluate the cost-effectiveness of ranibizumab and aflibercept from a UK healthcare perspective. Baseline characteristics, injection frequency and ranibizumab efficacy were based on the disease activity treatment arm from the RADIANCE study (n=116, Caucasian, Indian and East Asian patients). Data for aflibercept were derived from initial results for the aflibercept treatment arm from the MYRROR study (n=90, East Asian patients only). Relative efficacy was assessed by indirect comparison. An evaluation using the East Asian subgroup of the ranibizumab disease activity treatment arm in RADIANCE (n=35) was also conducted. RESULTS Ranibizumab dominated aflibercept in both evaluations. Based on the disease activity arm from RADIANCE, ranibizumab was associated with a lower lifetime cost (incremental cost -£1770) and higher lifetime quality-adjusted life-years (QALYs) (incremental gain 0.02) than aflibercept. Results were similar for the evaluation based on the East Asian subgroup. Ranibizumab was associated with a lower lifetime cost (incremental cost -£2856) and higher lifetime QALYs (incremental gain 0.06) than aflibercept. These results were driven by the greater number of injections, higher treatment and recurrence costs, and smaller proportion of patients gaining ≥20 letters visual acuity for aflibercept compared with ranibizumab. CONCLUSIONS This initial analysis suggests that ranibizumab is less costly and is associated with a gain in QALYs relative to aflibercept based on the disease activity arm and the East Asian subgroup from RADIANCE, as well as initial data from MYRROR.