Cost Analysis of Aflibercept 8 mg Versus Aflibercept 2 mg for the Treatment of Diabetic Macular Edema in the PHOTON Trial

Purpose: To compare the direct and indirect costs of aflibercept 8 mg with aflibercept 2 mg in patients with diabetic macular edema (DME) using the published data from the PHOTON trial. Methods: Three groups of patients with DME were compared: 163 patients under a protocol of aflibercept 2 mg every 8 weeks, 328 patients under a protocol of aflibercept 8 mg every 12 weeks, and 167 patients under a protocol of aflibercept 8 mg every 16 weeks. A model-based comparative analysis was conducted using estimates of direct and indirect costs based on the mean number of injection visits and mean number of injections administered at the end of 96 weeks in the PHOTON aflibercept 8 mg clinical trial. The costs were adjusted for inflation to 2025 US dollars. Results: Using point estimates of real-world data, patients in the aflibercept 8 mg every 16 weeks group had the lowest overall total costs (mean $32,259.54), followed by those in the aflibercept 8 mg every 12 weeks group (mean $37,550.14). Patients in the aflibercept 2 mg every 8 weeks group had the highest total costs (mean $41,124.26). Cost differences were primarily driven by the higher number of injection visits in the 2 mg every 8 weeks regimen compared with the higher-dose, extended-interval 8 mg schedules at 96 weeks. Multi-way deterministic sensitivity analysis showed that the aflibercept 8 mg every 16 weeks regimen was the least costly option across all 10 000 Monte Carlo cost simulations. Conclusions: Across both deterministic and simulated analyses, aflibercept 8 mg at extended dosing intervals (every 12 or 16 weeks) resulted in statistically significant cost savings compared with the standard 2 mg every 8 weeks regimen.