Comparison of Outcomes and Costs of Ranibizumab and Aflibercept Treatment in Real-Life

PLoS One. 2015 Aug 4;10(8):e0135050. doi: 10.1371/journal.pone.0135050. eCollection 2015.


Background: Treatment efficacy and costs of anti-VEGF drugs have not been studied in clinical routine.

Objective: To compare treatment costs and clinical outcomes of the medications when adjusting for patients' characteristics and clinical status.

Design: Comparative study.

Setting: The largest public ophthalmologic clinic in Switzerland.

Patients: Health care claims data of patients with age-related macular degeneration, diabetic macula edema and retinal vein occlusion were matched to clinical and outcome data.

Measurements: Patients' underlying condition, gender, age, visual acuity and retinal thickness at baseline and after completing the loading phase, the total number of injections per treatment, the visual outcome and vital status was secured.

Results: We included 315 patients (19595 claims) with a follow-up time of 1 to 99 months (mean 32.7, SD 25.8) covering the years 2006-2014. Mean age was 78 years (SD 9.3) and 200 (63.5%) were female. At baseline, the mean number of letters was 55.6 (SD 16.3) and the central retinal thickness was 400.1 μm (SD 110.1). Patients received a mean number of 15.1 injections (SD 13.7; range 1 to 85). Compared to AMD, adjusted cost per month were significantly higher (+2174.88 CHF, 95%CI: 1094.50-3255.27; p<0.001) for patients with DME, while cost per month for RVO were slightly but not significantly higher. (+284.71 CHF, 95% CI: -866.73-1436.15; p = 0.627).

Conclusions: Patients with DME are almost twice as expensive as AMD and RVO patients. Cost excess occurs with non-ophthalmologic interventions. The currently licensed anti-VEGF medications did not differ in costs, injection frequency and clinical outcomes. Linking health care claims to clinical data is a useful tool to examine routine clinical care.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Ambulatory Care Facilities / statistics & numerical data
  • Costs and Cost Analysis
  • Diabetic Retinopathy / drug therapy*
  • Diabetic Retinopathy / economics
  • Female
  • Health Care Costs / statistics & numerical data
  • Humans
  • Insurance Claim Review
  • Macular Degeneration / drug therapy*
  • Macular Degeneration / economics
  • Macular Edema / drug therapy*
  • Macular Edema / economics
  • Male
  • Ranibizumab / economics
  • Ranibizumab / therapeutic use*
  • Receptors, Vascular Endothelial Growth Factor / economics
  • Receptors, Vascular Endothelial Growth Factor / therapeutic use*
  • Recombinant Fusion Proteins / economics
  • Recombinant Fusion Proteins / therapeutic use*
  • Retinal Vein Occlusion / drug therapy*
  • Retinal Vein Occlusion / economics
  • Tomography, Optical Coherence
  • Treatment Outcome
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors
  • Visual Acuity


  • Recombinant Fusion Proteins
  • VEGFA protein, human
  • Vascular Endothelial Growth Factor A
  • aflibercept
  • Receptors, Vascular Endothelial Growth Factor
  • Ranibizumab

Grant support

An unrestricted educational grant was awarded to Oliver Reich (OR) and Andri Signorell (AS) by Novartis Pharma Schweiz AG, Switzerland. The funder had no role in study design; collection, analysis, and interpretation of data; writing of the paper; or in the decision to submit the paper for publication. Lucas Bachmann (LB) is an employee of medignition Inc. OR and AS are employees of the Helsana Health Insurance Company. These funders provided support in the form of salaries but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of all authors are articulated in the ‘author contributions’ section.