Treatment Options for Age-Related Macular Degeneration: A Budget Impact Analysis from the Perspective of the Brazilian Public Health System

BACKGROUND: Age-related macular degeneration (AMD) is a disease that causes reduced visual acuity and blindness. The new treatment options for AMD are not provided by the Brazilian public health system. OBJECTIVE: To conduct a budget impact analysis of three scenarios for the introduction of AMD treatments: all the medications (verteporfin, ranibizumab, and bevacizumab–the reference scenario), ranibizumab alone, and bevacizumab alone. METHODS: The basic assumption was that the Brazilian public health system would treat the entire target population with AMD aged > 70 years between 2008 and 2011. The size of the population of interest was estimated from official population projections and the prevalence of the disease was obtained from a systematic review. Medication prices were estimated by weighting their market values with correction factors to take account of the public procurement policy. The possibility of aliquoting bevacizumab was also considered. A panel of experts was consulted to estimate the market share of the different medications for the reference scenario. The incremental costs of the ranibizumab-alone and bevacizumab-alone scenarios compared to the reference scenario were calculated. Univariate sensitivity analyses were run to check the robustness of the model. RESULTS: In four years, the Brazilian public health system would have treated 1,136,349 individuals with AMD. The annual costs of treating one patient would have been US$476.65 for bevacizumab, US$11,469.39 for ranibizumab, and US$4,376.28 for verteporfin. The incremental cost of the ranibizumab-alone scenario would have been US$1,878,318,056.00 in four years, while the incremental cost for the bevacizumab-alone scenario would have been a reduction of US$4,978,326,359.00 (i.e., a cost saving) in the same period. The bevacizumab-alone option was found to represent a cost saving across sensitivity analyses. CONCLUSION: The introduction of bevacizumab for the treatment of AMD is recommended for the Brazilian Public Health System.