A cost analysis comparing continued 3-year aflibercept monotherapy versus a switch from aflibercept to the fluocinolone acetonide intravitreal implant in phakic patients with chronic diabetic macular edema

Abstract

Objectives: To compare the 3-year cost in the NHS in England of continued aflibercept injections with that of switching to a single fluocinolone acetonide (FAc) intravitreal implant in phakic patients with chronic diabetic macular edema (DME); that is, DME that persists or recurs despite treatment. Methods: A cost analysis model was developed. This accounts for the overall direct cost of treatment in phakic eyes, including the costs of the drugs, administration, monitoring, additional interventions required, and adverse event management. Results: This model shows cost savings for patients with a phakic lens when they are switched to FAc following initial aflibercept monotherapy. Using NHS list prices, the total treatment cost over a 3-year period per phakic eye is £15,413.23 with continued aflibercept monotherapy and £14,485.06 with a switch to FAc–resulting in a cost saving with FAc of £928.17 per eye over a 3-year period. Conclusions: This cost analysis showed that switching patients with an initial suboptimal response from aflibercept to FAc was associated with a cost advantage compared with continued aflibercept injections. With increasing demand for intravitreal therapies, the true benefit of treatment with FAc may be its potential as a suitable and effective option to increase clinic capacity.