Summary: economic burden and resource utilization

In 2024, Medicare Part B spending was $2.37 billion for aflibercept 2 mg (Eylea), $1.92 billion for faricimab (Vabysmo), $0.67 billion for aflibercept 8 mg (Eylea HD), and $0.13 billion for ranibizumab (Lucentis); these totals include all approved indications (for example, diabetic macular edema and retinal vein occlusion), not neovascular AMD alone. In 2020, aflibercept was the second-highest Medicare Part B drug by total spending (more than $3 billion). In a US commercial claims cohort of 6,076 participants with neovascular AMD, annual neovascular AMD-related outpatient visit costs were $8,658 for active choroidal neovascularization compared with $2,406 for inactive disease. In a US survey of 200 participants, mean annual societal ophthalmic costs were $39,910 with visual loss and $6,116 with good vision, rising to $82,984 at 20/800 or worse. Each treatment visit required a mean of 90 minutes in clinic, and patients reported almost 12 hours per visit including travel and recovery. In the IRIS Registry, 11.6% of 156,327 treatment-naive participants were lost to follow-up within 12 months.

Medicare Part B spending on intravitreal anti-VEGF products, 2024 (all indications)

HCPCS code and product	Total spending, 2024 ($)	Claims, 2024	Beneficiaries, 2024
J0178 aflibercept 1 mg (Eylea)	“2365369089”	“1233027”	“293280”
J2777 faricimab-svoa 0.1 mg (Vabysmo)	“1918151107”	“792936”	“172503”
J0177 aflibercept hd 1 mg (Eylea Hd)	“665780687.8”	“211930”	“66767”
J2778 ranibizumab 0.1 mg (Lucentis)	“128919304.6”	“144995”	“33741”
J9035 bevacizumab 10 mg (Avastin)	“161538584.4”	“342609”	“98961”

Medicare Part B spending on AMD therapies, 2020

“Aflibercept was the second most expensive drug by total spending for the Medicare Part B program in 2020, with more than $3 billion in annual costs, while ranibizumab was the sixth most expensive drug by total spending, costing more than $1 billion; spending on aflibercept and ranibizumab together was more than 10% of the total Medicare Part B drug spending for 2020.” (opens the source at this quote in a new tab)
“These cost differences have implications for both the Medicare program and beneficiaries, as these patients are liable for 20% of the treatment cost.” (opens the source at this quote in a new tab)

Medicare Part B spending per beneficiary, 2011 to 2015

“On average, Medicare spent $9719 and $9934 annually on each beneficiary receiving ranibizumab and aflibercept injections, respectively.” (opens the source at this quote in a new tab)
“Ranibizumab and aflibercept costs account for 12% of the Medicare Part B budget annually.” (opens the source at this quote in a new tab)

Medicare average sales prices for anti-VEGF agents

“Medicare Part B average sales prices for ranibizumab 0.3 mg, ranibizumab 0.5 mg, and aflibercept 2 mg were $776, $1,292, and $1,806, respectively, as of October 2022.” (opens the source at this quote in a new tab)
“Consequences of untreated neovascular AMD include a substantial economic burden on patients, their family, and society.” (opens the source at this quote in a new tab)

Direct costs and resource use by disease activity: US commercial claims

“A total of 6,076 patients with nAMD were identified for the prevalent cohort; 60.1%, 17.2%, and 5.9% had active CNV, inactive CNV, and inactive scar disease stage at index, respectively. The nAMD-related outpatient visit costs were roughly 4 and roughly 7 times higher, respectively, for the active CNV group ($8,658 [SD = $11,612]) compared with the inactive CNV ($2,406 [SD = $5,510]) and inactive scar ($1,198 [SD = $3,035]) groups (P < 0.0001).” (opens the source at this quote in a new tab)
“A total of 3,623 prevalent patients (59.6%) were eligible for the anti-VEGF treatment patterns analysis (mean [SD] duration of therapy = 7.7 [4.5] months; mean [SD] number of injections = 6.0 [3.7]).” (opens the source at this quote in a new tab)

Societal costs by visual acuity in the better-seeing eye

“The mean annual societal cost for the Control Cohort was $6,116 and for the Study Cohort averaged $39,910 (P < 0.001). Study Subcohort 1 costs averaged $20,339, while Subcohort 4 costs averaged $82,984.” (opens the source at this quote in a new tab)
“Total societal ophthalmic costs associated with neovascular age-related macular degeneration dramatically increase as vision in the better-seeing eye decreases.” (opens the source at this quote in a new tab)

Treatment burden: time-and-motion study

“Fifty-six physicians provided data for 221 patients with neovascular AMD. Patients accounted for 20% of the health care staff's time per week, with an average of 23 staff members. An average patient visit for neovascular AMD was 90 minutes (range: 13 minutes to >4 hours). Patients reported an average time per visit of almost 12 hours, including preappointment preparation (16 minutes), travel (66 minutes), waiting time (37 minutes), treatment time (43 minutes), and postappointment recovery (9 hours).” (opens the source at this quote in a new tab)

Loss to follow-up during anti-VEGF therapy: IRIS Registry

“For neovascular AMD, 11.6% of patients (95% CI, 11.4%-11.7%) were LTFU, and 88.4% of patients were followed up within 12 months.” (opens the source at this quote in a new tab)
“Nearly 1 of 9 patients with neovascular AMD treated with anti-VEGF injections became LTFU, whereas 1 of 7 patients were nonpersistent.” (opens the source at this quote in a new tab)

Annual per-patient costs in commercially insured neovascular AMD, 2018 US dollars

“All costs were adjusted to 2018 US dollars using the medical care component of the Consumer Price Index.” (opens the source at this quote in a new tab)
“We estimated an annual all-cause cost for patients with nAMD of $24,520 per patient, whereas newly diagnosed patients incurred slightly lower costs ($18,943).” (opens the source at this quote in a new tab)
“The nAMD-related outpatient costs represented 28% of total costs and 44% of total outpatient costs, respectively, and were driven primarily by anti-VEGF injection-related costs” (opens the source at this quote in a new tab)

Annual healthcare resource utilization by baseline disease status: US commercial claims

Visits over 12 months, mean (SD)	All prevalent nAMD (N = 6,076)	Active CNV (N = 3,653)	Inactive CNV (N = 1,046)	Inactive scar (N = 358)
All-cause outpatient visits	“30.6 (26.4)”	“31.0 (25.5)”	“27.5 (25.3)”	“27.1 (25.9)”
nAMD-related outpatient visits	“6.6 (4.8)”	“7.7 (4.6)”	“4.1 (3.5)”	“2.9 (2.9)”
Anti-VEGF-related outpatient visits	“3.9 (4.2)”	“5.1 (4.2)”	“1.3 (2.5)”	“0.5 (1.6)”
Optical coherence tomography test-related visits	“4.5 (3.5)”	“5.4 (3.6)”	“2.9 (2.6)”	“1.6 (1.9)”

Determinants of neovascular AMD-related outpatient costs

“Significant drivers of total nAMD-related costs were the initial anti-VEGF agent and anti-VEGF injection frequency” (opens the source at this quote in a new tab)
“Multivariate GLM results revealed an increasing trend in costs with increasing anti-VEGF injection frequency; there were 73% higher costs for patients with 4-6 injections to 342% higher costs for those with 10 or more injections compared with those with 1-3 injections over 1 year of follow-up” (opens the source at this quote in a new tab)

Anti-VEGF injection frequency and treatment disruption by initial agent

“Mean duration of therapy (SD) and mean (SD) number of injections was lowest for the bevacizumab group (n = 1,876 [51.8%]; 6.0 [4.6] months and 4.8 [3.3] injections, respectively) compared with the ranibizumab (n = 539 [14.9%]; 7.6 [4.4] months and 6.0 [3.6] injections, respectively) and aflibercept groups (n = 1,208 [33.3%]; 7.9 [4.4] months and 6.1 [3.9] injections, respectively).” (opens the source at this quote in a new tab)
“Nearly half (48.3%) of all patients (n = 1,750) had a treatment disruption.” (opens the source at this quote in a new tab)

Staff members and staff time dedicated to neovascular AMD management per retina practice

Staff type	Average number involved in neovascular AMD care (range)	Average percentage of a 40-hour work week spent in neovascular AMD care (range)	Average hours per week spent on neovascular AMD, all staff members
Receptionist	“5 (1–18 people)”	“20% (1%–75%)”	“28 hours”
Office manager	“2 (0–10 people)”	“13% (0%–75%)”	“10 hours”
Billing manager	“2 (0–6 people)”	“22% (0%–80%)”	“18 hours”
Technician, including photographer, scribe and lead technician	“8 (1–50 people)”	“34% (3%–90%)”	“112 hours”
Physicians other than retina specialists	“2 (0–18 people)”	“15% (0%–65%)”	“12 hours”
Other staff, including medical assistants, optometrists and nurse technicians	“4 (1–12 people)”	“25% (5%–70%)”	“40 hours”

Retina specialist reported burden of monitoring and injection frequency

“When asked about the impact of activities for monitoring and injection administration on staff time, the majority of the surveyed retina specialists (62%, 35 of 57) felt that frequency of patient monitoring placed a significant burden on staff time. A large percentage of retina specialists (58%, 33 of 57) felt that billing and filing for reimbursement was also a significant burden on staff resources.” (opens the source at this quote in a new tab)
“Forty-nine percent (28 of 57) of retina specialists reported that the frequency of injections was an impactful burden on office space, including waiting rooms and examination rooms.” (opens the source at this quote in a new tab)
“Two-thirds of physicians (38 of 57) stated they would find it very desirable to reduce office visits.” (opens the source at this quote in a new tab)

Duravyu (vorolanib intravitreal insert)

Economic burden and healthcare resource utilization