Pharmacoeconomic analysis of brolucizumab therapy in patients with diabetic macular edema
Objective. Pharmacoeconomic analysis of anti-VEGF drugs (brolucizumab and aflibercept) in adults with diabetic macular edema (DME). Material and methods. We analyzed literature data regarding clinical efficacy of brolucizumab, aflibercept and ranibizumab in the treatment of adults with DME. We performed cost-minimisation analysis for brolucizumab and aflibercept in 3 scenarios of anti-VEGF therapy in the Russian Federation (consideration of only the cost of anti-VEGF drugs in medical care and intravitreal injections in inpatient medical care using payment system for diagnosis-related groups and high-tech medical care). Results. Phase III randomized clinical trials (RCTs) with active control KESTREL and KITE of brolucizumab and aflibercept in adults with DME demonstrated similar efficacy of brolucizumab 6 mg and aflibercept 2 mg regarding best corrected visual acuity after 52 weeks. However, brolucizumab required fewer injections to achieve disease control compared to aflibercept. Cost minimization analysis of the cost of drug therapy alone showed that total cost of annual managing of one patient with brolucizumab was 58% lower compared to aflibercept therapy. Cost minimization analysis showed that total cost of annual inpatient therapy in one patient with brolucizumab was 29% lower compared to aflibercept for both scenarios. Sensitivity analysis confirmed robustness of study results in fluctuations of the price of the drugs within ± 20% for scenario with calculation of cost only for the drugs and annual incidence of intravitreal injections within ±2 injections for scenario with calculation of costs for intravitreal injections within the diagnosis-related groups and high-tech medical care. Conclusion. Brolucizumab therapy in adults with DME reduces direct medical costs and volume of medical care compared to aflibercept.