Objective:

To evaluate the impact of start-and-switch decisions on healthcare costs in treatment-naïve wet AMD patients specifically.

Key Findings:

• 54% of nAMD patients began treatment with compounded bevacizumab.
• 26% switched to another agent within a year, increasing to 40% over 3 years, highlighting significant cost implications.
• Cost of care for patients switching from bevacizumab to branded agents rose from approximately $700 to $20,000 over 3 years.
• In the Medicare Advantage cohort, 70% started with bevacizumab, with over half switching, primarily to aflibercept.

Interpretation:

Switching from low-cost bevacizumab to branded anti-VEGF agents significantly increases healthcare costs, with potential quality issues in compounded drugs contributing to high switch rates, which may also affect patient outcomes.

Limitations:

• The study may not account for all factors influencing treatment decisions and costs, such as patient preferences and clinical guidelines.
• Real-world data may vary based on patient demographics and healthcare settings, which could impact generalizability.

Conclusion:

Further investigation is needed to understand the reasons behind frequent switching and the potential benefits of an approved ophthalmic formulation of bevacizumab, which could stabilize treatment patterns and costs.