Evicenter
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4D-150

Neovascular age-related macular degeneration

Regulatory status
Not announced
Launch
Not announced
Last updated
180 sources

Cost-effectiveness analyses and utility weights

Published cost-effectiveness analyses and health-state utility weights that a model of this product could cite, adapt, or compare against, grouped by how each article relates to the product and its indication. Every value is quoted from the article it cites, and section 3 lists the searches that found the articles.

11 cost-effectiveness analyses and 7 studies reporting utility weights · 12 sources

Overview

ItemDetail
Literature searchedTufts Medical Center Cost-Effectiveness Analysis Registry, searched October 21, 2026; the queries are listed in section 3.
Cost-effectiveness analyses11
Studies reporting utility weights7

Cost-effectiveness analyses

Analyses of 4D-150

No evidence found.

Treatments for the same indication

Bevacizumab, ranibizumab, and aflibercept versus no treatment in neovascular age-related macular degeneration, United States: Brown et al. (2020)

Relevance: Compares intravitreal bevacizumab, ranibizumab, and aflibercept with observation in neovascular age-related macular degeneration in the United States, including aflibercept, the active comparator in the 4FRONT-1 trial.

“To perform 11- and 2-year health care sector (ophthalmic) and societal cost perspective reference case, cost-utility analyses comparing bevacizumab, ranibizumab, and aflibercept monotherapies for neovascular age-related macular degeneration (NVAMD).” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“We employed patient utilities, bilateral outcomes, 2018 U.S. dollars, vision-related mortality, a Medicare fee schedule, and CATT (Comparison of Age-Related Macular Degeneration Treatments) study and VIEW (VEGF Trap-Eye: Investigation of Efficacy and Safety in Wet AMD) trial.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“A combined-eye model cost basis was used.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“a 3% annual discount rate for QALY outcomes and costs” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“Bevacizumab and ranibizumab each conferred an 11-year, 1.339 QALY gain versus observation. Aflibercept conferred a 1.380 QALY gain.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“The average ophthalmic cost perspective CUR for bevacizumab was $11,033/QALY, $79,600/QALY for ranibizumab, and $44,801/QALY for aflibercept.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“Aflibercept conferred greater QALY gain for less cost than ranibizumab but was not cost-effective compared to bevacizumab ($1,151,451/QALY incremental CUR).” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“The 11-year model ophthalmic cost perspective and societal cost perspective, incremental CURs comparing aflibercept to bevacizumab were both $1,147,273/QALY (Table 7)” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“Aflibercept was more effective than ranibizumab because it provided greater patient value gain (QALY gain) for less cost than ranibizumab” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“Two-year therapy prevented a 1-month-of-life loss, and revealed bevacizumab, ranibizumab, and aflibercept conferred 0.141, 0.141, and 0.164 QALY gains, respectively, with corresponding average CURs of $40,371/QALY, $335,726/QALY, and $168,006/QALY, respectively.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

Aflibercept 2 mg every 8 weeks versus monthly and as-needed ranibizumab in wet age-related macular degeneration, United States: Hernandez et al. (2018)

Relevance: Compares the aflibercept regimen of the 4FRONT-1 comparator arm with monthly and as-needed ranibizumab over a lifetime horizon from a U.S. payer perspective.

“To assess the cost-effectiveness of intravitreal aflibercept injection 2 mg every 8 weeks after 3 initial monthly doses (IAI 2q8) versus ranibizumab 0.5 mg monthly (Rq4) and pro re nata (PRN) in the treatment of patients with wAMD from a U.S. payer perspective.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“A Markov cohort model was developed to estimate the lifetime quality-adjusted life-years (QALYs) and costs of treating patients with wAMD with IAI 2q8, Rq4, and ranibizumab PRN.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“Utilities and costs (in 2016 U.S. dollars) were from published literature. Health outcomes and costs were discounted at an annual rate of 3%.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“Over a lifetime, IAI 2q8 provided equal health benefits with Rq4 (5.44 QALYs) at a lower total cost ($33,745 vs. $48,031) as a result of fewer injections.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“IAI 2q8 yielded greater QALYs compared with ranibizumab PRN (5.440 vs. 5.404) at a higher cost ($33,745 vs. $33,652), with an incremental cost per QALY gained of $2,583 (i.e., IAI 2q8 was cost-effective vs. ranibizumab PRN).” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“A treatment was deemed cost-effective at ICERs below a willingness-to-pay (WTP) threshold of $50,000 per QALY gained.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“The PSA results indicate that compared with Rq4, IAI 2q8 was cost-effective in all simulations, being dominant in 46% of them. Compared with ranibizumab PRN, IAI 2q8 was cost-effective in 98% of all simulations” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

Brolucizumab versus aflibercept and ranibizumab in wet age-related macular degeneration, United States: Yu et al. (2021)

Relevance: Compares brolucizumab with aflibercept, the active comparator in the 4FRONT-1 trial, and with ranibizumab over a lifetime horizon from a U.S. health care payer perspective.

“A Markov model was developed in Microsoft Excel to model the treatment of wet AMD patients with brolucizumab compared with aflibercept and ranibizumab over a lifetime time horizon (base case) and 5-year time horizon (scenario analysis) from a US payer perspective.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“The Markov model consisted of 3 primary health states: on treatment, off treatment, and death.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“In the base case, outcomes and costs were discounted at a rate of 3% annually.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“In the base case, brolucizumab was less costly than aflibercept ($63,614 vs $72,189), and brolucizumab generated 0.0079 more quality-adjusted life-years (QALYs) than aflibercept (4.580 vs 4.572).” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“Since brolucizumab was less costly and more effective than aflibercept, an ICER value was not calculated, as brolucizumab was a dominant treatment over aflibercept.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“Additionally, brolucizumab was less costly than ranibizumab ($63,614 vs $128,163) and generated 0.0078 more QALYs than ranibizumab (4.580 vs 4.572) in the base case.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“Since brolucizumab was less costly and more effective than ranibizumab, an ICER value was not calculated, as brolucizumab was a dominant treatment over ranibizumab.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

Ranibizumab port delivery system versus intravitreal ranibizumab injections in neovascular age-related macular degeneration, United States: Brown et al. (2024)

Relevance: Evaluates the ranibizumab port delivery system, a treatment listed in section 2, against intravitreal ranibizumab injections from U.S. direct medical and societal cost perspectives.

“To quantify the cost-utility ratio of the ranibizumab Port Delivery System (PDS; SUSVIMO) versus intravitreal ranibizumab injections for treating neovascular age-related macular degeneration (nAMD) based upon Archway Phase 3 Trial data.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“Ophthalmic patient, time tradeoff utilities, direct medical and societal cost perspectives, 12-year, 1-year, and 5-year timelines, United States 2022 real dollars, and a 3% annual discount rate were employed.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“Versus no therapy, the 1-year PDS QALY gain was 0.0156 (6.8%) versus 0.0063 (0.82%) for intravitreal injections (P < 0.001), whereas the respective 12-year QALY gains were 1.714 (28%) and 1.639 (26.8%) (P = 0.99).” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“The 1-year incremental PDS $/QALY versus injections was cost effective at $75 497/QALY.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“Five-year PDS therapy was not incrementally cost effective at $304 108/QALY, nor was the 12-year therapy at $761 646/QALY.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“Average 12-year cost-utility ratios were $78 773/QALY for the PDS and $47 917/QALY for injection therapy.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“Adding -$476 442 12-year offsetting societal costs netted $314 521 to society per PDS participant versus $370 958 per participant for injection therapy.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

Monthly and as-needed bevacizumab and ranibizumab in newly diagnosed neovascular age-related macular degeneration, United States: Stein et al. (2014)

Relevance: Compares monthly and as-needed bevacizumab and ranibizumab, anti-VEGF therapies listed in section 2, in newly diagnosed neovascular age-related macular degeneration in the United States from a societal perspective.

“We developed a Markov model to capture the total costs and HRQL for patients with newly diagnosed neovascular AMD under four treatment options: monthly bevacizumab injections, as-needed bevacizumab injections, monthly ranibizumab injections, and as-needed ranibizumab injections.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“A societal perspective was taken to encompass all parties affected by the treatment choice: patients, providers, and payers.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“The model followed a hypothetical cohort of patients aged 80 years (the mean age for neovascular AMD onset) with neovascular AMD (as defined in CATT) over a 20-year time horizon.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“All costs are in 2012 U.S. dollars. Costs and health utilities were discounted at 3% annually.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“Over 20 years, the expected costs for a single patient with newly diagnosed neovascular AMD receiving monthly bevacizumab, as-needed bevacizumab, monthly ranibizumab, and as-needed ranibizumab were $79 771, $65 267, $257 496, and $163 694, and the QALYs for a patient receiving these treatments were 6.66, 6.60, 6.68, and 6.64, respectively.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“The ICER of monthly bevacizumab over as-needed bevacizumab was $242 357/QALY. The ICER of monthly ranibizumab over as-needed bevacizumab was $10 708 377/QALY. As-needed ranibizumab was dominated by monthly bevacizumab because monthly bevacizumab had lower costs and higher QALYs” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

Faricimab versus ranibizumab, aflibercept, brolucizumab, and best supportive care in neovascular age-related macular degeneration and diabetic macular edema, Japan: Yanagi et al. (2025)

Relevance: Evaluates faricimab, a bispecific anti-VEGF and angiopoietin-2 antibody listed in section 2, against ranibizumab, aflibercept, brolucizumab, and best supportive care in Japan, with the ratios shown limited to those for neovascular age-related macular degeneration.

“A Markov model for cost-effectiveness analysis of anti-VEGF treatment in patients with nAMD and DME was applied based on cost and utility value data from Japan.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“Faricimab administered through a treat-and-extend (T&E) regimen was compared with ranibizumab administered pro re nata (PRN) and T&E, aflibercept T&E, brolucizumab T&E, and best supportive care (BSC).” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“Further to treatment costs (public payer perspective), the societal burden (societal perspective), including costs of travel, informal care, and productivity, was assessed.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“In treatment of nAMD, lifetime quality-adjusted life years (QALYs) gained were highest with faricimab (faricimab T&E: 6.92, ranibizumab PRN: 6.88, ranibizumab T&E: 6.91, aflibercept T&E: 6.89, brolucizumab T&E: 6.89, BSC: 5.99).” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“From the public payer perspective, the lifetime total cost for faricimab T&E was lower than those for ranibizumab (PRN, T&E) and brolucizumab (T&E), comparable to aflibercept T&E, and higher than BSC (incremental costs: 158,385 and 6,475,511 JPY, respectively).” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“As a result, faricimab was cost-effective or dominant in the treatment of nAMD, excluding BSC.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“From the societal perspective, faricimab was dominant against all comparators in nAMD.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

Brolucizumab versus aflibercept in neovascular age-related macular degeneration, Italy: Ferrante et al. (2022)

Relevance: Compares brolucizumab with aflibercept, the active comparator in the 4FRONT-1 trial, over a lifetime horizon from an Italian health care sector perspective.

“The simulation of costs and outcomes was carried out using a Markov model over a time horizon of 15 years.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“patients with a mean age of 75.8 years at the beginning of the model are observed over a time horizon of 15 years (equivalent to a lifetime horizon, given age at beginning of simulation). A discount rate of 3.0% was applied to costs and outcomes.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“The Italian National Healthcare Service (NHS) perspective was considered, therefore only healthcare direct costs (treatment acquisition, administration, adverse events, disease monitoring) were analysed.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“In the base-case analysis, brolucizumab was dominant over aflibercept (+ 0.11 years QALY gained and -€15,679 costs).” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“The results of the probabilistic sensitivity analysis showed that when the willingness to pay is equal to €50,000 per QALY gained, brolucizumab would be dominant in 84% of simulations and in the remaining simulations brolucizumab would be cost-effective compared to aflibercept.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

Aflibercept versus bevacizumab and ranibizumab in wet age-related macular degeneration, Finland: Vottonen and Kankaanpää (2016)

Relevance: Compares aflibercept, the active comparator in the 4FRONT-1 trial, with monthly bevacizumab and with ranibizumab in a model of both eyes in wet age-related macular degeneration from the perspective of a Finnish university hospital.

Access: Not open access

Not quoted: The results are reported in the full text, which is closed access.

The same disease in other populations or settings

No evidence found.

Related diseases and analogous treatments

Voretigene neparvovec versus standard of care in biallelic RPE65-mediated retinal disease, United States: ICER final evidence report (2018)

Relevance: Evaluates voretigene neparvovec, a one-time subretinal AAV gene therapy for RPE65-mediated retinal disease, against standard of care from U.S. health care system and modified societal perspectives, an analogue for pricing a one-time intravitreal AAV gene therapy such as 4D-150.

“We developed a de novo Markov model with two general health states” (opens the source at this quote in a new tab)

“Therefore, we also included an analysis using a modified societal perspective which included direct medical costs as well as indirect costs for education and productivity loss, and direct non-medical costs for informal care, transportation, and nursing home care.” (opens the source at this quote in a new tab)

“We used a 3% discount rate for costs and health outcomes. The model used one-year cycles over a lifetime time horizon.” (opens the source at this quote in a new tab)

“All costs were adjusted to 2017 US dollars.” (opens the source at this quote in a new tab)

“In the population receiving VN at age 15, the average total lifetime cost for individuals treated with VN was approximately $1,039,000 from a US health care system perspective.” (opens the source at this quote in a new tab)

“Voretigene neparvovec provided an additional 1.3 QALYs over the remaining lifetime of an individual, leading to an incremental cost-effectiveness ratio of approximately $644,000 per additional QALY gained from the US health care system perspective, and $480,000 per additional QALY gained from the modified societal perspective.” (opens the source at this quote in a new tab)

“In the population receiving VN at age 3, the average total lifetime cost for individuals treated with VN was approximately $962,000 from a US health care system perspective.” (opens the source at this quote in a new tab)

“Voretigene neparvovec provided an additional 2.7 QALYs over the remaining lifetime of an individual, leading to an incremental cost-effectiveness ratio of approximately $288,000 per additional QALY gained from the US health care system perspective, and $135,000 per additional QALY gained from the modified societal perspective.” (opens the source at this quote in a new tab)

Voretigene neparvovec versus standard of care in biallelic RPE65-mediated inherited retinal disease, United States: Zimmermann et al. (2019)

Relevance: Evaluates voretigene neparvovec, a one-time ocular AAV gene therapy, against standard of care over a lifetime horizon from U.S. healthcare system and modified societal perspectives.

“We modeled the cost-utility of VN compared with standard of care (SoC).” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“A 2-state Markov model, alive and dead, with a lifetime horizon.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“VN led to an improvement in VA and VF that we assumed was maintained for 10 years followed by a 10-year waning period.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“The cost of VN was $850 000, and other direct medical costs for depression and trauma were included for a US healthcare system perspective. A modified societal perspective also included direct nonmedical costs and indirect costs.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“VN provided an additional 1.3 QALYs over the remaining lifetime of an individual.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“The average total lifetime direct medical cost for individuals treated with VN was $1 039 000 compared with $213 400 for SoC, leading to an incremental cost-effectiveness ratio (ICER) of $643 800/QALY from the US healthcare system perspective.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“Direct nonmedical costs totalled $1 070 900 for VN and $1 203 300 for SoC, and indirect costs totalled $405 400 for VN and $482 900 for SoC, leading to an ICER of $480 100/QALY from the modified societal perspective.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

Voretigene neparvovec-rzyl versus standard care in RPE65-mediated inherited retinal disease, United States: Johnson et al. (2019)

Relevance: Evaluates voretigene neparvovec-rzyl, a one-time ocular AAV gene therapy, against standard care over a lifetime horizon in the United States.

“In this economic analysis, a health state transition model based on visual acuity and field with a lifetime horizon was developed to estimate the cost-effectiveness of voretigene neparvovec-rzyl.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“Indirect costs, including educational attainment, productivity, caregiver burden, and governmental programs, were estimated using published literature and data analysis of public national surveys.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“Costs and benefits were discounted at 3.0% annually.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“The model population included 70 patients with RPE65 -mediated IRD, with a mean age of 15 years; 42 of 70 patients (60%) were female.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“Voretigene neparvovec-rzyl had higher QALYs (18.1 vs 8.6) and lower total lifetime costs ($2.2 million vs $2.8 million) than SC (ie, was dominant) when including indirect costs, resulting in cost-savings and QALY increases. When indirect costs were excluded, the cost per QALY was $79 618.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“Voretigene neparvovec-rzyl remains cost-effective if at least 8.8% of the long-term treatment effect continues after year 3 when including indirect costs and 43.3% when excluding indirect costs, assuming a cost threshold of $150 000 per quality-adjusted life-year.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

Utility weights

Utility weights from analyses of 4D-150

No evidence found.

Utility weights for the same indication

Utility weights by visual acuity, neovascular age-related macular degeneration: Brown et al. (2024)

Relevance: Ophthalmic patient time tradeoff utilities, adjusted for neovascular conversion in fellow eyes, used in a U.S. model of the ranibizumab port delivery system in neovascular age-related macular degeneration.

Access: Not open access

Not quoted: The utility weights are reported in the full text, which is closed access.

Utility weights by best-corrected visual acuity and for long-term adverse events, neovascular age-related macular degeneration: Stein et al. (2013)

Relevance: Utilities by best-corrected visual acuity range, blindness from endophthalmitis, stroke, and myocardial infarction used in a U.S. model of anti-VEGF treatment for neovascular age-related macular degeneration.

Utility weights for two-eye health states by visual acuity of the better-seeing eye, wet age-related macular degeneration: Vottonen and Kankaanpää (2016)

Relevance: Utilities for health states defined by the visual acuity of the better-seeing eye in a model of both eyes in wet age-related macular degeneration.

Access: Not open access

Not quoted: The utility weights are reported in the full text, which is closed access.

Utility weights for the same disease in other populations or settings

No evidence found.

Utility weights for related diseases and analogous treatments

No evidence found.

Search strategy

DatasetQueryResults
Ratios"macular degeneration"198
Ratios"neovascular" OR "wet AMD" OR "choroidal neovascularization"140
Ratiosaflibercept134
Ratiosfaricimab31
Ratiosranibizumab221
Ratiosbevacizumab AND ("macular" OR "intravitreal")116
Ratiosbrolucizumab32
Ratiosvoretigene OR "inherited retinal"11
Ratios"gene therapy" AND ("retinal" OR "ocular" OR "eye")5
Ratiosfluocinolone OR "dexamethasone implant" OR "dexamethasone intravitreal" OR Ozurdex OR Iluvien10
Ratios"port delivery"3
Ratiospegaptanib OR verteporfin61
Ratiosbiosimilar AND (ranibizumab OR bevacizumab OR aflibercept)50
Methods"4D-150" OR "4DMT"0
Weights"macular degeneration"297
Weights"neovascular" OR "wet AMD" OR "nAMD"174
Weightsendophthalmitis OR "intraocular inflammation" OR "retinal detachment"50
Weights"intravitreal injection" OR "injection burden"31
Ratios"sustained release" OR "sustained-release" OR "intravitreal implant" OR "drug delivery"56