From a financial standpoint, not all anti-VEGF treatment strategies are equally suited to monitoring at home with optical coherence tomography (OCT). According to an economic analysis presented at the American Society of Retina Specialists (ASRS) annual meeting in Montreal, the break-even point depends largely on the anti-VEGF agent being used, the frequency of injection, and how the clinic manages physician review of home OCT scans.

Sean Berkowitz, MD, MBA, a vitreoretinal surgery fellow at the Cole Eye Institute of Cleveland Clinic, presented a modeling study evaluating the 1-year economic profile of home OCT monitoring (Scanly; Notal Vision) compared with standard office-based management for neovascular age-related macular degeneration (nAMD). The analysis incorporated 2026 Medicare reimbursement rates and drug costs, and considered preliminary CPT codes for home OCT.

“We wanted to evaluate payer costs of implementing home OCT monitoring for nAMD, determinants of break-even conditions, and physician scan interpretation burden,” Dr. Berkowitz explained. The analysis found that cost neutrality varied considerably by treatment regimen. Home OCT was not cost-effective for patients receiving bevacizumab (Avastin; Genentech) or ranibizumab (Lucentis; Genentech) at any injection interval evaluated. “What we found was that for agents like bevacizumab and ranibizumab, even monthly injections, it is less costly to do standard treatment compared to home OCT,” Dr. Berkowitz said.

For higher-cost agents—including aflibercept 2 mg (Eylea; Regeneron), aflibercept 8 mg (Elyea HD; Regeneron), and faricimab (Vabysmo; Genentech)—home OCT became increasingly favorable only when it enabled fewer injections each year. For patients receiving aflibercept 2 mg, cost neutrality required reducing treatment by 6 injections annually. The corresponding reductions were 5 injections per year for faricimab and 4 injections per year for aflibercept 8 mg. Among patients receiving approximately 12 injections annually, extending treatment intervals by roughly 2 to 4 weeks could approach cost neutrality, depending on the agent, said Dr. Berkowitz (Figure 1).

The analysis also examined physician workload associated with remote monitoring. In a simulated practice managing 100 patients, reviewing every submitted home OCT scan would require approximately 20.7 hours of physician review each week. Restricting review to the latest scan reduced that workload to 0.77 hours per week—a 96.2% reduction.

“The burden on physicians quickly balloons up,” Dr. Berkowitz said. “For a 100-patient roster, every single scan per patient per month, we go up to 21 hours per week, whereas if you're only reviewing the latest scans, it's much more manageable."

He noted that artificial intelligence–assisted triage could substantially influence the feasibility of home monitoring. “The physician review burden is very dependent on which types of methods you’re using for screening and flagging scans,” he said.

Dr. Berkowitz emphasized that the model focused on payer costs and did not incorporate patient or caregiver burden or the potential clinical benefits of home monitoring. He also noted that the ultimate economic value of home OCT will continue to evolve as reimbursement changes over time for the category III CPT codes used for home OCT, and that data from the DRCR Retina Network’s ongoing Protocol AO trial will further define the technology’s role (Figure 2).

In a panel discussion that followed Dr. Berkowitz’s presentation, Christina Y. Weng, MD, MBA, mentioned that the modeling study findings align with how she anticipates the technology will be used in the future. “When you think about these longer durability therapeutics in the pipeline … that’s really where I think the natural marriage between home OCT technology and the way we treat patients really lies,” she said. “To be able to increase our confidence in monitoring while simultaneously decreasing the visit burden would be a welcome shift for most.” RP