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Journal : The Indonesian Journal of General Medicine

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Which Anti-VEGF Therapy (Ranibizumab, Bevacizumab, or Aflibercept) Demonstrates The Most Cost-Effective Outcomes For Treating Age-Related Macular Degeneration ? : A Systematic Review Olivia Putri Chairunnisa; Mia Audina; Irawati
The Indonesian Journal of General Medicine Vol. 12 No. 3 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/vbsedq58

Abstract

Introduction: Age-related macular degeneration (AMD), particularly its neovascular form (nAMD), is a leading cause of irreversible vision loss in the elderly. Anti-vascular endothelial growth factor (anti-VEGF) therapies, including ranibizumab, bevacizumab, and aflibercept, have revolutionized treatment by inhibiting pathological angiogenesis. However, their high costs and varying efficacy profiles necessitate a comprehensive evaluation of cost-effectiveness to guide clinical and policy decisions. Methods: This systematic review adhered to PRISMA 2020 guidelines, analyzing 40 studies from databases like PubMed, Sagepub, and Google Scholar. Inclusion criteria focused on adult AMD patients treated with anti-VEGF agents, reporting both clinical outcomes (e.g., visual acuity, central retinal thickness) and cost data. Data extraction included study design, intervention details, patient demographics, visual outcomes, cost-effectiveness metrics, and adverse events. Results: Bevacizumab emerged as the most cost-effective option, with annual costs significantly lower than ranibizumab and aflibercept (e.g., €27,087/year vs. +€4,000–€6,000). All three agents showed comparable efficacy in visual acuity improvements, though aflibercept required fewer injections (7.0/year vs. ranibizumab’s 5.8/year). Safety profiles were similar, but bevacizumab was associated with marginally higher systemic risks. Economic analyses highlighted bevacizumab’s dominance in incremental cost-effectiveness ratios (ICERs), while aflibercept’s reduced injection frequency offered potential long-term savings. Discussion: Despite bevacizumab’s economic advantages, its off-label status and safety concerns limit universal adoption. Ranibizumab and aflibercept, though FDA-approved, present higher financial burdens. Geographic disparities in drug pricing and dosing regimens further influence cost-effectiveness. Emerging agents like brolucizumab show promise but require long-term safety data. Conclusion: Bevacizumab is the most cost-effective anti-VEGF therapy for nAMD, balancing efficacy and affordability. Policymakers should prioritize its inclusion in formularies, especially in resource-limited settings, while addressing regulatory and safety barriers.
Co-Authors Abdul Kadir Jaelani Jaelani Abdul Mirad Abdul Rahman Abdurahman Abdus Salam, Abdus AFRIANDI Aguswan Al Jauzi, Nailan Kinan Alfareski, David Alfat, Sayahdin Alvinto, Bintang Alwi Alya Amelia An'nisa Pratama Putri Ananda, Rima Andi Hilal Miftah Fauzan Andi Primafira B. Eka Andri Rusta Andriani, Rita Anggraini Anggraini ani, Inriani ANISAH Anjar Budi Astoro Arlistria Muthmainnah Arman Artiasari, A. Asmadin Atika Pratiwi Ayu Levia Tryana Baharuddin Baharuddin Bahdat Baso Amri Busaeri, Mohamad Chahyani, Rani Chatarina Umbul Wahyuni Chikmah Dona Sunita Christianto, Leonardus Cinthia Kartikaningtias Dasa Ismaimuza Dessy Mita Mariana Malau Devi Delawati Dewiyanti Dinanti, Mutiara Dwi Herlinda Edy Purnomo Elfirza Rosiana Enny Radjab Erinaldi Erni Lubis Erwanda, Alifianisa Erwin Mardinata Fabanyo, Rizqi Alvian Fajarwaty Kusumawardhani Fathurrahmad Fatma, Fatmawati Ferinaldi Fidella Irtza Nathania Fikri, Yudistia Teguh Ali Fitra Yeni Gaffar, Andi Widya Mufila Galih Maulana Azkiya Handoko, Tito Hasan, Erzam S Hasri, Diah Anggeraini Hasri Herdianti Darwis Herman Herry Imran Hilman Alawi, Muhammad Fadillah Hosan Ihwana As’ad Ikhwan Ahmad Fiqqih Imanuela Indah Pertiwi Intan Liana Iqbal, Firdaus Muhamad Irfan Suliansyah Irfandi Rahman Jannatun Aliyah Jibril Dihya Azzikra, Muhammad Junaidi Junaidi Katherine Kho Kelpin Mendonga Khairun Nisa Khusni Albar, Mawi Kistan Kistan Lembah Andriani Lilis Nur Hayati M. Oscar Magfirah, Magfirah Maliki, Budi Ilham Mardiana MARDIANA Mas'ud, Alfian Mas’ud, Alfian Maulid Adha, Wahyu Megat Norulazmi Megat Mohamed Noor Mhd Fajri Mia Audina Moh rizal asry Yusuf Muammar Khaddafi Mude, Muh. Aliyazid Muh Asrul Muh. Ashdaq Muhammad Fajri Muhammad Nawab Alawi Murniati, Sarly Musni Ni Nyoman Wulan P. I Nirwana Wulandari Novi Damayanti, Novi Novia Sandra Dewi Novriani, Fitria Nur Ariyandani Nur Fitriayu Mandasari nurpeni Nursyam Anwar NURUL HIKMAH Olivia Putri Chairunnisa Puput Juliarna Syarif Puspitafuri, Cindy Rahmad Zaki Ramadhan, Muhammad Aryo Ravi Joentera Rayessandi Retnaningtyas, Erma Retno Palupi Yonni Siwi Reza Muhammad Rizqi Rida Jelita Rifda Ningsi Rifma Rika Arfiana Rikar Parenden Rini Setyaningsih Ritonga, Elda Nurmawan Rivai, Dian Rahmayanti Rizal Zaki Ramadhan Rizky Fan Surya, Aufa Rosalina Rosliana Eso Ruslihardy Ryan Suarantalla Sabrifha, Eli Sampeata, Sulkifli sari, sari susanti Satria Nugraha Sibulo, Megawati Siti Fatimah Siti Helmyati Sri Rahcamawati Askar Sri Utami Permata Sri Yeni St. Malka Sukur Suryati Syamsudin Syamzaimar Titin Wahyuni Batamba Tomy Dwi Cahyono Trio Saputra Trio Saputra Tuhfatul Janan Ulhaq, Muhammad Dhiya Ulhaq Wahdaniah Widia Astuti Widya Khoirun Nisa Wilia Ismiyarti Wulan Ayuandiani Wulandari, Futri Ayu Yadi Sutikno Yahya Yosita Sipapa’ YUNUS Zahra Nabila Sukmana Zulaika, Amanda