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Background/Objective <p>Neovascular age-related macular degeneration (nAMD) imposes a substantial clinical and economic burden in the United States (US). Faricimab offers the potential for longer dosing intervals than aflibercept, but its economic value in the US setting has not been established. This study evaluated the cost utility of faricimab versus aflibercept for treating nAMD from the US payer perspective.</p> Methods <p>A Markov model of five health states defined by best-corrected visual acuity (BCVA) simulated disease progression over 5 years. Clinical inputs were drawn from pooled 1-year data of the TENAYA and LUCERNE phase III trials (<i>n</i>&#xa0;=&#xa0;1329), which compared faricimab with aflibercept for treating nAMD patients. Direct medical costs encompassed drug acquisition, intravitreal administration, monitoring, office visits, and management of endophthalmitis. Outcomes included total costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER), and net monetary benefit (NMB) at a willingness-to-pay (WTP) threshold of US$100,000/QALY. Scenario, deterministic, and probabilistic sensitivity analyses (10,000 iterations) were conducted.</p> Results <p>In the base case, faricimab yielded 2.80 QALYs for US$52,797, whereas aflibercept produced 2.72 QALYs at US$62,367. Faricimab was therefore dominant (− US$9570; + 0.08 QALY), with an incremental NMB of US$17,981. Faricimab required markedly fewer injections over 5 years (22.6 vs 34). Scenario analyses did not materially change the directionality of the base-case results, with faricimab being dominant or cost effective. The model was most sensitive to drug acquisition prices and BCVA-state utilities, yet faricimab remained below the WTP threshold across all plausible ranges. Probabilistic analysis showed a 97% probability of faricimab being cost effective at US$100,000/QALY.</p> Conclusions <p>Faricimab is estimated to be a cost-effective treatment option compared with aflibercept for nAMD from a US payer perspective. This finding may support its inclusion in treatment guidelines and formulary decisions, pending confirmation in real-world practice.</p>

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Cost-Utility Analysis of Faricimab Versus Aflibercept in Treating Neovascular Age-Related Macular Degeneration (nAMD) in the United States

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月6日

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  • Ahmead Baljoon,
  • Vakaramoko Diaby,
  • Sandra Suther,
  • Matthew Dutton,
  • Askal Ali,
  • Islam Eljilany

摘要

Background/Objective

Neovascular age-related macular degeneration (nAMD) imposes a substantial clinical and economic burden in the United States (US). Faricimab offers the potential for longer dosing intervals than aflibercept, but its economic value in the US setting has not been established. This study evaluated the cost utility of faricimab versus aflibercept for treating nAMD from the US payer perspective.

Methods

A Markov model of five health states defined by best-corrected visual acuity (BCVA) simulated disease progression over 5 years. Clinical inputs were drawn from pooled 1-year data of the TENAYA and LUCERNE phase III trials (n = 1329), which compared faricimab with aflibercept for treating nAMD patients. Direct medical costs encompassed drug acquisition, intravitreal administration, monitoring, office visits, and management of endophthalmitis. Outcomes included total costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER), and net monetary benefit (NMB) at a willingness-to-pay (WTP) threshold of US$100,000/QALY. Scenario, deterministic, and probabilistic sensitivity analyses (10,000 iterations) were conducted.

Results

In the base case, faricimab yielded 2.80 QALYs for US$52,797, whereas aflibercept produced 2.72 QALYs at US$62,367. Faricimab was therefore dominant (− US$9570; + 0.08 QALY), with an incremental NMB of US$17,981. Faricimab required markedly fewer injections over 5 years (22.6 vs 34). Scenario analyses did not materially change the directionality of the base-case results, with faricimab being dominant or cost effective. The model was most sensitive to drug acquisition prices and BCVA-state utilities, yet faricimab remained below the WTP threshold across all plausible ranges. Probabilistic analysis showed a 97% probability of faricimab being cost effective at US$100,000/QALY.

Conclusions

Faricimab is estimated to be a cost-effective treatment option compared with aflibercept for nAMD from a US payer perspective. This finding may support its inclusion in treatment guidelines and formulary decisions, pending confirmation in real-world practice.