Cost analysis comparing adjuvant epimacular brachytherapy with anti-VEGF monotherapy for the management of neovascular age-related macular degeneration

Abstract

Aims To consider the cost implication of adopting epimacular brachytherapy (EMB) for the treatment of neovascular (wet) age-related macular degeneration (wAMD), compared with ranibizumab or bevacizumab monotherapy. Methods This analysis compared the cumulative 3-year costs of anti-VEGF (vascular endothelial growth factor) monotherapy to EMB combined with anti-VEGF therapy. Two patient groups were considered: newly diagnosed (treatment-naïve) patients; and patients already receiving chronic anti-VEGF therapy. Results In the treatment-naïve patients, the highest cumulative treatment costs were associated with ranibizumab monotherapy (d25 658), followed by bevacizumab monotherapy (d16 177), EMB with ranibizumab (d14 002), then EMB with bevacizumab (d10 289). In previously treated patients, the highest treatment costs were ranibizumab monotherapy (d18 355), followed by EMB with ranibizumab (d17 428), bevacizumab monotherapy (d16 177), then EMB with bevacizumab (d12 129). Conclusion EMB combined with anti-VEGF treatment has the potential to yield considerable cost savings, compared with anti-VEGF monotherapy. If the ongoing large studies of EMB confirm the published feasibility data, then adjuvant EMB may represent a cost-effective alternative to anti-VEGF monotherapy.

Current Knowledge and Trends in Age-Related Macular Degeneration

“…110 Proton beam radiation was administered 2 weeks to 6 weeks after enrollment with a dose of 24 GyE in two 12 GyE fractions, 24 hours apart. [112][113][114] However, recent results from a multicenter study conducted in Europe: The study of strontium90 beta radiation with Lucentis to treat age-related macular degeneration (CABERNET, NCT00454389), which enrolled 457 treatment-naive patients, 115 failed to demonstrate a visual benefit with a mean loss of 2.5 letters among patients allocated to the radiation group against a gain of 4.4 letters for the control group that used a modified PIER protocol. 110 Furthermore, the mean number of ranibizumab injections was 4.5 at 12 months and 6.0 at 24 months, significantly less than other clinical trials where ranibizumab was also used as PRN treatment.…”

Therapies for Neovascular Age-Related Macular Degeneration: Current Approaches and Pharmacologic Agents in Development

“…A small scale study yielded positive results for the use of EMB in adjunct with bevacizumab with a mean gain of 8.9 letters in VA at 12 months [ 53 ]. However, the Epimacular Brachytherapy for Neovascular Age-related Macular Degeneration (CABERNET) study, a multicenter trial, did not endorse the use of EMB as a monotherapy [ 47 , 54 ]. The mean VA change at Month 12 compared to baseline for EMB was −0.5 letters with relatively higher incidence of cataract formation and disease progression.…”

In vitro evaluation of simulated stereotactic radiotherapy for wet age-related macular degeneration on three different cell lines

“…The search for alternative therapies led to the investigation of stereotactic radiotherapy (SRT) using low-dose X-ray irradiation on the macular region of nAMD patients 4 , 5 . Through reduction of the needed anti-VEGF injection number, irradiation would, for one, lower the treatment cost of nAMD 6 . Hypothetically, possible morphological benefits include the reduction of an inflammatory response 7 , the inhibition of fibroblasts and therefore the reduction of scar formation 8 and the death of rapidly dividing endothelial cells 9 .…”