Beyond drug price: A comparison of overall costs of anti‐vascular endothelial growth factor therapy alternatives for neovascular age‐related macular degeneration in Norway

Purpose Norwegian guidelines designate off‐label Avastin as the first‐line intravitreal therapy for neovascular age‐related macular degeneration ( nAMD ) because of its well‐documented clinical efficacy and low price. However, this overlooks non‐drug costs, which increase with injection frequency. We evaluated whether newer, longer‐acting agents offer greater long‐term cost‐efficiency by reducing total costs despite higher drug prices in a Norwegian setting. Methods We developed a 2‐year cost‐minimization model that included pharmaceutical, consultation and administrative and patient‐related costs in Norway; the pharmaceutical cost component incorporated the routine practice of splitting vials into prefilled syringes in hospital pharmacies. The model compared four nAMD monotherapies, Avastin, Eylea 2 mg, Eylea 8 mg and Vabysmo, as well as the common practice of switching treatment‐resistant patients from Avastin to Eylea 2 mg. We derived injection frequencies from clinical trials (for monotherapies) or observational data (for switching) and conducted one‐way sensitivity analyses to identify key cost drivers. Results Over 2 years, the switching regimen had the highest per‐patient cost (146 722 NOK), followed by Eylea 2 mg (100 481 NOK), Vabysmo (93 207 NOK), Avastin (86 262 NOK) and Eylea 8 mg (68 738 NOK). Avastin had the lowest drug cost, but its high injection frequency increased non‐drug costs. Sensitivity analyses showed that injection frequency strongly influenced total costs for high‐priced drugs, while patient time had a substantial impact for Avastin. Conclusion In our model, longer‐acting agents reduced injection frequency and decreased overall treatment costs. These findings suggest that adopting longer‐acting monotherapy could improve cost‐efficiency in long‐term nAMD management in Norway.