AAO 2023: Analysis of pegcetacoplan for cost-effective treatment of geographic atrophy

The study showed that every-other-month treatment was more cost-effective than monthly treatment, investigators reported. Image credit: ©everythingpossible – stock.adobe.com

Reviewed by Nimesh A. Patel, MD

Pegcetacoplan injection (Syfovre, Apellis Pharmaceuticals, Inc.) is the first intravitreal therapy approved by the FDA to treat geographic atrophy (GA). However, because there is no gain in vision associated with the treatment, lead study author Nimesh A. Patel, MD pointed out the need for novel utility metrics.

Patel, from the Department of Ophthalmology, Massachusetts Eye and Ear, Boston, described the study at the American Academy of Ophthalmology annual meeting in San Francisco, California. He collaborated with investigators from the Bascom Palmer Eye Institute, Miami, Florida, and Vitreoretinal Consultants of New York, Great Neck, New York, both in the United States.

The purpose of this investigation was 2-fold: to estimate the costs of treating GA with pegcetacoplan and to identify possible utility measures to compare treatments for GA.

Patel explained that the investigation was modeled on the 2-year data from the DERBY and OAKS studies, the costs were based on Medicare allowables and the assumed costs for treating choroidal neovascular membranes. In addition, the lifetime model was based on the life expectancies of the study population, the rate of GA loss was based on 2-year data, and the upper limit of GA was defined as the total area of the macula.

Analysis results

The results showed that the 2-year cost per RPE cell saved versus sham was $8.43 and every month and $4.86 for every other month. The marginal cost, ie, every month compared with every other month, per RPE cell saved was $30. The cost per area of RPE saved in the extrafoveal group was $53,900/mm2 for every month treatment and $32,100/mm2 for every other month treatment, Patel reported.

The lifetime model indicated that the time to when the GA involved 95% of the macula was 14.0 years with monthly treatment, 13.6 years with every other month treatment, and 11 years for sham treatment.

Regarding the lifetime cost per area, the analysis showed that the costs per quality adjusted life year gained based on the modeled visual loss with 95% atrophy were $643,000 with monthly treatment and $372,000 with every other month treatment.

Image courtesy of Nimesh A. Patel, MD

The investigators concluded that the study defined novel metrics of effectiveness and utility for GA as the cost/area of GA saved and the cost per retinal pigment epithelial (RPE) cell. The study also showed that every-other-month treatment was more cost-effective than monthly treatment and that treatment of extrafoveal lesions was more cost effective than treating all lesions.

“There is a significant cost to treating GA and these metrics will help to determine which treatments are most cost-effective as other options become available,” Patel concluded.