Implantable Anti-VEGF Device Less Cost Effective Than Injections

Senile Macular Degeneration
Age Related Macular Degeneration, Also Called Senile Macular Degeneration. Choroidal Neovascularization. Photograph Of The Back Of Eye. (Photo By BSIP/UIG Via Getty Images)
Although the injections were deemed more cost effective, they require a long recovery time, that can last up to 8 hours.

Ranibizumab port delivery system (PDS) is more expensive than traditional methods of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections across scenarios, according to a cost-effectiveness study published in JAMA Ophthalmology.

Researchers completed a cost analysis to compare the prices of ranibizumab PDS with that of intravitreal anti-VEGF injections (including ranibizumab, aflibercept, and bevacizumab injections) for 1- and 5-year periods. Data on ranibizumab PDS and anti-VEGF injections were collected from prior 2 studies. Cost information on both treatments was collected from the 2022 Centers for Medicare and Medicaid (CMS) Physical Fee Schedule and from manufacturers. A break-even analysis was conducted to find how many months of anti-VEGF injections would match the price of PDS (cost calculated from implantation alone, a single refill, and 2 refills). Cost models were created to compare total cost of both treatments for 1 year and 5 years.

Researchers found that a mean of 6.4±0.8 ranibizumab injections, 5.5±0.7 aflibercept injections, and 34.5±4.2 bevacizumab injections were needed to break even with PDS implantation alone. A mean of 10.8±1.3 ranibizumab injections, 9.3±1.1 aflibercept injections, and 58.1±7.1 bevacizumab injections were needed to break even with PDS implantation and a single refill. A mean of 15.2±1.9 ranibizumab injections, 13.1±1.6 aflibercept injections, and 81.6±10.0 bevacizumab injections were needed to break even with PDS implantation and 2 refills. 

Cost models show that, in a 1-year period, ranibizumab PDS has a mean cost of $21,016 and monthly ranibizumab injections cost $1943 (95% CI, -$3047 to $6932; P =.34) more, monthly aflibercept injections cost $5702 (95% CI, $253-$11 151; P =.04) more, monthly bevacizumab injections cost $16,732 (95% CI, -$20 170 to -$13 294, P <.001) less, and bimonthly aflibercept injections $7658 (95% CI, -$11,649.52 to -$3665.61; P =.006) less. Spanning a 5-year period, ranibizumab PDS is predicted to cost a mean of $89,218 and predicted cost of monthly ranibizumab injections were $25 581 (95% CI, $2275-$48 887; P =.04) more, monthly aflibercept injection were $44 374 (95% CI, $18 623-$70 125; P =.008) more, monthly bevacizumab were $67,793 (95% CI, -$82 501 to -$53 085; P <.001), and bimonthly aflibercept injections were $22,422 (95% CI, -$40 287 to -$45,56; P =.03) less.

The study concludes that ranibizumab PDS is only more affordable when refills are provided as needed (as opposed to fixed refills) compared with intravitreal ranibizumab and aflibercept injections. However, researchers also state, “the decreased treatment burden of ranibizumab PDS has important considerations as quality of life may be improved with less injections” and note that recovery from injections can last up to 8 hours. 

Limitations of this study include the exclusion of some data from the 2 studies used to model the current study, the use of current practice patterns to assume future costs, and the lack of incorporation of clinical effectiveness.    


Sood S, Mandell J, Watane A, Freidman S, Parikh R. Cost of ranibizumab port delivery system vs intravitreal injections for patents with neovascular age-related macular degeneration. JAMA Ophthalmol. Published online June 16, 2022. doi:10.1001/jamaophthalmol.2022.1819