Cost-effectiveness of intravitreal therapy in Age-Related Macular Degeneration

Piergiorgio Neri, Ilir Arapi, Chiara Maria Eandi, Vittorio Pirani, Cesare Mariotti, Alfonso Giovannini



Age-related macular degeneration (AMD) is still referred to as the leading cause of severe and irreversible visual loss world-wide. Advances in medical research have identified vascular endothelial growth factor (VEGF) as an important pathophysiological player in neovascular AMD and intraocular inhibition of VEGF as one of the most efficient therapies. Anti-VEGFs currently used to treat AMD included a monoclonal antibody (bevacizumab), an antibody fragments (ranibizumab), a fusion protein (aflibercept), and an aptamer (pegaptanib). The wide introduction of anti-VEGF therapy has led to an improvement in the prognosis of patients affected by AMD, with a consequent effects on the burden of care due to highly priced drugs, increasing patient numbers, and long-term disease chronicity. Aim of this review is to present an overview of available therapeutic strategies in AMD in term of clinical efficacy and economic sustainability.


Age-Related Macular Degeneration; Anti-VEGF; Intravitreal injection

Full Text



  • Rosenfeld PJ, Brown DM, Heier JS, et al.; MARINA Study Group. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 2006; 355: 1419-31;
  • Brown DM, Kaiser PK, Michels M, et al.; ANCHOR Study Group. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med 2006; 355: 1432- 44;
  • Regillo CD, Brown DM, Abraham P, et al. Randomized, double-masked, sham-controlled trial of ranibizumab for neovascular age-related macular degeneration: PIER Study year 1. Am J Ophthalmol 2008; 145: 239-48;
  • Boyer DS, Heier JS, Brown DM, et al. A Phase IIIb study to evaluate the safety of ranibizumab in subjects with neovascular age-related macular degeneration. Ophthalmology 2009; 116: 1731-9;
  • Lalwani GA, Rosenfeld PJ, Fung AE, et al. A variable-dosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration: year 2 of the PrONTO Study. Am J Ophthalmol 2009; 148: 43-58;
  • CATT Research Group, Martin DF, Maguire MG, Ying GS, et al. Ranibizumab and bevacizumab for neovascular age-related macular degeneration. N Engl J Med 2011; 364: 1897-908;
  • Chakravarthy U, Harding SP, Rogers CA, et al.; IVAN study investigators. Alternative treatments to inhibit VEGF in age-related choroidal neovascularisation: 2-year findings of the IVAN randomised controlled trial. Lancet 2013; 382: 1258-67;
  • Wolf A, Kampik A. Efficacy of treatment with ranibizumab in patients with wet age-related macular degeneration in routine clinical care: data from the COMPASS health services research. Graefes Arch Clin Exp Ophthalmol 2014; 252: 647-55;
  • Sivaprasad S, Tadayoni R. Retrospective analysis of the real-world utilization of ranibizumab in wAMD. AURA Steering Committee. Presented at the 2013 Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO); Seattle, 2013. Abstract 3836
  • Rakic J-M, Leys A, BriĆ© H, et al. Real-world variability in ranibizumab treatment and associated clinical, quality of life, and safety outcomes over 24 months in patients with neovascular age-related macular degeneration: the HELIOS study. Clin Ophthalmol 2013; 7: 1849-58;
  • Heier JS, Brown DM, Chong V, et al.; VIEW 1 and VIEW 2 Study Groups. Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology 2012; 119: 2537-48;
  • Brown DM, Heier JS, Clark WL, et al. Intravitreal aflibercept injection for macular edema secondary to central retinal vein occlusion: 1-year results from the phase 3 COPERNICUS study. Am J Ophthalmol 2013; 155: 429-37;
  • Do DV, Nguyen QD, Boyer D, et al.; DA VINCI Study Group. One-year outcomes of the DA VINCI Study of VEGF Trap-Eye in eyes with diabetic macular edema. Ophthalmology 2012; 119: 1658-65;
  • Cho H, Shah CP, Weber M, et al. Aflibercept for exudative AMD with persistent fluid on ranibizumab and/or bevacizumab. Br J Ophthalmol 2013; 97: 1032-5;
  • Bakall B, Folk JC, Boldt HC, et al. Aflibercept Therapy for Exudative Age-related Macular Degeneration Resistant to Bevacizumab and Ranibizumab. Am J Ophthalmol 2013; 156: 15-22;
  • Hughes MS, Sang DN. Safety and efficacy of intravitreal bevacizumab followed by pegaptanib maintenance as a treatment regimen for age-related macular degeneration. Ophthalmic Surg Lasers Imaging 2006; 37: 446-54
  • Friberg TR, Tolentino M, LEVEL Study Group, et al. Pegaptanib sodium as maintenance therapy in neovascular age-related macular degeneration: the LEVEL study. Br J Ophthalmol 2010; 94: 1611-17;
  • Gragoudas ES, Adamis AP, Cunningham Jr ET, et al.; VEGF inhibition study in ocular neovascularization clinical trial group. Pegaptanib for neovascular age-related macular degeneration. N Engl J Med 2004; 351: 2805-16;
  • Mitchell P1, Annemans L, White R, et al. Cost effectiveness of treatments for wet age-related macular degeneration. Pharmacoeconomics 2011; 29: 107-31;
  • Cicchetti A, Ruggeri M. Valutazione economica di ranibizumab vs pegaptanib o vs terapia fotodinamica con verteporfina. JPH 2009; 6(Suppl. 3): 31-44
  • Holz FG, Bandello F, Gillies M, et al.; LUMINOUS Steering Committee. Safety of ranibizumab in routine clinical practice: 1-year retrospective pooled analysis of four European neovascular AMD registries within the LUMINOUS programme. Br J Ophthalmol 2013; 97: 1161-7;
  • Nishimura Y, Taguchi M, Nagai T, et al. Comparison of the effect between pegaptanib and ranibizumab on exudative age-related macular degeneration with small lesion size. Clin Ophthalmol 2012; 6: 365-8
  • Neri P, Mariotti C, Arapi I, et al. Anti vascular endothelial growth factor sequential therapy for neovascular age-related macular degeneration: is this the new deal? Curr Med Res Opin 2012; 28: 395-400;
  • Foxton RH, Finkelstein A, Vijay S, et al. VEGF-A is necessary and sufficient for retinal neuroprotection in models of experimental glaucoma. Am J Pathol 2013; 182: 1379-90;


Abstract: 1283 views
HTML: 1235 views
PDF: 637 views


  • There are currently no refbacks.