{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T02:19:15Z","timestamp":1788920355396,"version":"build-2803163510"},"reference-count":24,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      Norwegian guidelines designate off\u2010label Avastin as the first\u2010line intravitreal therapy for neovascular age\u2010related macular degeneration (\n                      <jats:styled-content style=\"fixed-case\">nAMD<\/jats:styled-content>\n                      ) because of its well\u2010documented clinical efficacy and low price. However, this overlooks non\u2010drug costs, which increase with injection frequency. We evaluated whether newer, longer\u2010acting agents offer greater long\u2010term cost\u2010efficiency by reducing total costs despite higher drug prices in a Norwegian setting.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We developed a 2\u2010year cost\u2010minimization model that included pharmaceutical, consultation and administrative and patient\u2010related 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\u2009mg, Eylea 8\u2009mg and Vabysmo, as well as the common practice of switching treatment\u2010resistant patients from Avastin to Eylea 2\u2009mg. We derived injection frequencies from clinical trials (for monotherapies) or observational data (for switching) and conducted one\u2010way sensitivity analyses to identify key cost drivers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over 2\u2009years, the switching regimen had the highest per\u2010patient cost (146\u2009722 NOK), followed by Eylea 2\u2009mg (100\u2009481 NOK), Vabysmo (93\u2009207 NOK), Avastin (86\u2009262 NOK) and Eylea 8\u2009mg (68\u2009738 NOK). Avastin had the lowest drug cost, but its high injection frequency increased non\u2010drug costs. Sensitivity analyses showed that injection frequency strongly influenced total costs for high\u2010priced drugs, while patient time had a substantial impact for Avastin.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In our model, longer\u2010acting agents reduced injection frequency and decreased overall treatment costs. These findings suggest that adopting longer\u2010acting monotherapy could improve cost\u2010efficiency in long\u2010term nAMD management in Norway.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aos.70069","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T04:41:07Z","timestamp":1770007267000},"page":"551-558","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Beyond drug price: A comparison of overall costs of anti\u2010vascular endothelial growth factor therapy alternatives for neovascular age\u2010related macular degeneration in Norway"],"prefix":"10.1111","volume":"104","author":[{"given":"Jacopo F. T.","family":"L\u00f8kken","sequence":"first","affiliation":[{"name":"Centre for Educational Measurement, Faculty of Educational Sciences University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten Carstens","family":"Moe","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Oslo University Hospital  Oslo Norway"},{"name":"Institute of Clinical Medicine, Faculty of Medicine University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik Magnus","family":"S\u00e6ther","sequence":"additional","affiliation":[{"name":"Oslo Economics  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d8ystein Kalsnes","family":"J\u00f8rstad","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Oslo University Hospital  Oslo Norway"},{"name":"Institute of Clinical Medicine, Faculty of Medicine University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,1]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/aos.16774"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/13696998.2025.2536420"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2015.09.018"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2014.07.041"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41433-025-04020-9"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00417-019-04569-8"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/aos.17506"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/24741264241308496"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/aos.16598"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/aos.14825"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/aos.14177"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2024.02.014"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)00063-1"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-019-54226-7"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/IAE.0000000000003128"},{"key":"e_1_2_8_17_1","unstructured":"Norwegian Hospital Procurement Trust(2025). 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