Different Treatment Regimens Yield Different Costs for nAMD Patients

The introduction of brolucizumab resulted in savings in the manufacturer-recommended and real-world evidence regimens.

The costs of different treatment regimens can vary widely for patients with neovascular age-related macular degeneration (nAMD).

A team, led by Zasim Azhar Siddiqui, MS, School of Pharmacy, West Virginia University, estimated the budget impact of different treatment regimens of brolucizumab in patients with nAMD from a US payer perspective.

The Treatment and Regimens

Brolucizumab is an anti-vascular endothelial growth factor (anti-VEGF) that is currently approved by the US Food and Drug Administration (FDA) for the treatment of patients with nAMD. There are multiple treatment regimens available for nAMD, including manufacturer-recommended regimens, pro re nata (PRN) regimens, and treat-and-extend (T&E) regimens. However, these are based on clinical practice guidelines and data observed in clinical setting, classified as real-world evidence.

The majority of budget impact models forecast the financial consequences of adding a new drug to the formulary based on the manufacturer-recommended regimens.

In the study, the investigators used a budget impact model developed for different treatment regimens for brolucizumab over a 1 year time frame from a US payer perspective. They then performed a separate analysis to estimate the budget impact from a US patient population perspective.


The model inputs included drug costs, administration costs, physician visits costs, and disease monitoring costs and the outcomes in the budget impact model included the cost per member per month, the annual health plan cost, and the US patient population-based annual cost.

Next, they conducted a scenario analysis on the US population based on the prevalence of nAMD to account for the differences in the drug cost to the public and commercial payersFinally, the team did a 1-way sensitivity analyses to test model assumptions and uncertainty in model inputs.

The results show adding brolucizumab to the formulary increased the net budgetary impact under pro re nata and treat-and-extend regimens.

The maximum increase in expenditure for a hypothetical health plan with 1 million enrollees was associated with the pro re nata regimen ($824,696). This was followed by the treat-and-extend regimen ($163,101).

On the other hand, manufacturer-recommended and real-world evidence regimens resulted in an annual saving of $93,068 and $94,170 for the health plan, respectively.

The US patient population showed the introduction of brolucizumab resulted in savings in the manufacturer-recommended ($30.99 million) and real-world evidence regimens ($31.35 million). However, this led to an increase in annual expenditures for the pro re nata ($274.58 million) and treat-and-extend ($54.30 million) regimens.

“Payers need to evaluate the cost impact of different treatment regimens of existing and new anti-VEGFs when making formulary decisions in nAMD management,” the authors wrote.

The study, “Cost impact of different treatment regimens of brolucizumab in neovascular age-related macular degeneration: A budget impact analysis,” was published online in the Journal of Managed Care and Specialty Pharmacy.