OBJECTIVES: To evaluate the cost-effectiveness of ranibizumab compared with aflibercept for the treatment of neovascular (wet) age-related macular degeneration AMD from the UK healthcare provider perspective. METHODS: A patient simulation model was developed with best corrected visual acuity (BCVA) used as a marker of disease progression. Baseline patient characteristics were based on the EXCITE Phase III study. Change in BCVA for Year 1 and Year 2 were based on a network meta-analysis. Beyond Year 2 or after treatment discontinuation, BCVA in the treated eye was modelled using natural history data for wet AMD patients. Natural history data for the general population was used to model the untreated eye. BCVA change in each eye was modelled independently. A probability of developing bilateral disease was applied throughout the model. Utility values were estimated by a regression analysis of BCVA in the better-seeing eye (BSE) and in the worse-seeing eye (WSE). Three scenarios based on different treatment and monitoring schedules were analysed; pro-re-nata (PRN), treat and extend (T&E), observe and extend (O&E). The model assumed that 50% of patients were treated via one-stop monitoring, and 50% with two-stop monitoring. RESULTS: The difference in lifetime costs associated with ranibizumab (0.5mg) ranges from a saving of £22 with T&E regimen, to a reduction of £7,416 with a PRN regimen. In addition, ranibizumab was associated with lifetime quality-adjusted life years (QALYs) of 5.07 compared with 5.06 for aflibercept and as a consequence dominated aflibercept. Probabilistic sensitivity analysis suggests that the probability of ranibizumab (0.5mg) being cost-effective with a T&E regimen is 27% at a £20,000 threshold, and 30% at a £30,000 threshold. With a PRN regimen, the probability of cost-effectiveness was 86% at a £20,000 threshold and 86% at a £30,000 threshold. CONCLUSIONS: Ranibizumab dominates aflibercept for patients with neovascular AMD irrespective of treatment regimen.