{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T11:24:37Z","timestamp":1791545077243,"version":"4.3.4"},"reference-count":33,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"unspecified","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009473","name":"Universidad de M\u00e1laga","doi-asserted-by":"publisher","award":["Please note that this research received no specifi"],"award-info":[{"award-number":["Please note that this research received no specifi"]}],"id":[{"id":"10.13039\/100009473","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,9,12]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the cost-effectiveness of anti-vascular endothelial growth factor (VEGF) treatments for neovascular age-related macular degeneration (nAMD) using a value-based model that considers drug durability, dosing regimens and real-world administration strategies, including safe vial fractionation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and setting<\/jats:title>\n                    <jats:p>Model-based pharmacoeconomic analysis using data from randomised clinical trials and network meta-analyses. Analysis conducted from the payer perspective using cost data from the Spanish National Health System.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A model-based analysis compared five anti-VEGF agents\u2014innovator and biosimilar ranibizumab, aflibercept 2 mg, brolucizumab and faricimab\u2014across three dosing regimens: fixed, Pro Re Nata and Treat-and-Extend (TAE). Administration formats included single-use vials, prefilled syringes and vial fractionation (VF), with or without dead-space-free (DSF) syringes to minimise waste. The primary outcome was cost per optimal responder, defined as a patient gaining \u226515 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, with and without adverse events. Cost-effectiveness was evaluated using Number Needed to Treat (NNT), Net Efficacy Adjusted for Risk-NNT (adjusted for safety) and incremental cost-effectiveness ratios. Secondary outcomes included the number of treated patients and optimal responders achievable within a fixed \u20ac1 000 000 budget.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The most cost-effective strategy was aflibercept 2\u2009mg under a TAE regimen using DSF VF, with a total cost of \u20ac6214 per patient and a cost per optimal responder of \u20ac27\u2009155. Under a fixed budget of \u20ac1\u2009000\u2009000, this approach allowed treatment of 160 patients, yielding 36 optimal responders. Faricimab with DSF VF ranked second, with a total cost of \u20ac5847 and a cost per optimal responder of \u20ac28\u2009652, treating 171 patients and achieving 34 responders. In contrast, single-use vials without VF led to substantially higher total costs (eg, \u20ac11\u2009305 for aflibercept TAE) and lower treatment capacity (eg, 88 patients treated).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This model demonstrates that combining durable agents, extended dosing intervals and optimised delivery strategies (eg, prefilled syringes and DSF VF) can substantially improve the cost-effectiveness and sustainability of anti-VEGF therapy in public health systems.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-103539","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T05:26:17Z","timestamp":1759901177000},"page":"e103539","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Model-based pharmacoeconomic analysis of anti-VEGF strategies for neovascular age-related macular degeneration: a value-based comparison of real-world administration approaches"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7632-6045","authenticated-orcid":false,"given":"Saturnino Manuel","family":"Gismero Moreno","sequence":"first","affiliation":[{"name":"PhD student in Biomedicine, Translational Research, and New Health Technologies, Department of Pharmacology and Paediatrics, Universidad de M\u00e1laga Facultad de Medicina, M\u00e1laga, Andaluc\u00eda, Spain"},{"name":"Oftalmolog\u00eda, Hospital Universitario Costa del Sol, Marbella, Andaluc\u00eda, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"J\u00f3dar S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Department of Applied Economics (Statistics and Econometrics), University of M\u00e1laga, M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuria","family":"Garc\u00eda-Agua Soler","sequence":"additional","affiliation":[{"name":"IBIMA Plataforma Bionand, Universidad de M\u00e1laga Facultad de Medicina, M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Rivas Ruiz","sequence":"additional","affiliation":[{"name":"RICAPPS Researcher, Research and Innovation Unit, Hospital Universitario Costa del Sol, Marbella, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio J","family":"Garcia-Ruiz","sequence":"additional","affiliation":[{"name":"IBIMA Plataforma Bionand, Universidad de M\u00e1laga Facultad de Medicina, M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,10,7]]},"reference":[{"key":"2025120415054836000_15.10.e103539.1","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.ajo.2020.05.029","article-title":"Cost-Utility Analysis of VEGF Inhibitors for Treating Neovascular Age-Related Macular Degeneration","volume":"218","author":"Brown","year":"2020","journal-title":"Am J Ophthalmol"},{"key":"2025120415054836000_15.10.e103539.2","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.ajo.2020.07.010","article-title":"A Cost-Benefit Analysis of VEGF-Inhibitor Therapy for Neovascular Age-Related Macular Degeneration in the United States","volume":"223","author":"Brown","year":"2021","journal-title":"Am J Ophthalmol"},{"key":"2025120415054836000_15.10.e103539.3","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-022-07972-w","article-title":"Cost-effectiveness analysis of brolucizumab versus aflibercept for the treatment of neovascular age-related macular degeneration (nAMD) in Italy","volume":"22","author":"Ferrante","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"2025120415054836000_15.10.e103539.4","doi-asserted-by":"crossref","unstructured":"Quist SW , Nab H , Postma M , et al . 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