OBJECTIVES: To evaluate the cost-effectiveness of intravitreal aflibercept (IVT-AFL) compared with ranibizumab in the management of patients with macular oedema secondary to branch retinal vein occlusion (BRVO). METHODS: A 25-health-state Markov model considering ranges of visual acuity in both eyes was developed. Patients had a confirmed diagnosis of macular oedema secondary to BRVO and had best corrected visual acuity (BCVA) at baseline between 25 and 73 letters. The evaluation compared IVT-AFL 2mg with ranibizumab 0.5mg: the frequency of injections and monitoring were identical for both treatments, taken from randomised trials and a physician survey.  A systematic review and indirect comparison were conducted to determine the probabilities of gaining at least 15 BCVA letters from baseline to 6 months; BCVA was then extrapolated over time to determine costs and outcomes. Utilities were taken from published literature and costs were estimated from a UK payer perspective. Published drug prices were discounted to reflect patient access schemes.  Costs and benefits were discounted at 3.5%. RESULTS: The indirect comparison found that IVT-AFL was associated with a small numerical advantage in the likelihood of gaining 15 BCVA letters, compared with ranibizumab (median odds ratio = 1.08 95% Crl: 0.43-2.56). IVT-AFL was associated with a higher number of QALYs (0.045) per patient than ranibizumab. Both treatments are available to the National Health Service under confidential patient access schemes. Cost-effectiveness was estimated for a range of possible discounts for each treatment. At price parity, IVT-AFL reduces cost by £4 per patient and was a dominant therapy. Results were sensitive to the unit cost of the drugs used, to comparative efficacy and number of injections for both treatments.  CONCLUSIONS: IVT-AFL 2mg was found to offer greater QALYs and to be a cost-effective option when compared with ranibizumab 0.5mg in the management of macular oedema secondary to BRVO.