Purpose: Norwegian guidelines designate off-label Avastin as the first-line intravitreal therapy for neovascular age-related macular degeneration (nAMD) because of its well-documented clinical efficacy and low price. However, this overlooks non-drug costs, which increase with injection frequency. We evaluated whether newer, longer-acting agents offer greater long-term cost-efficiency by reducing total costs despite higher drug prices in a Norwegian setting.
Methods: We developed a 2-year cost-minimization model that included pharmaceutical, consultation and administrative and patient-related costs in Norway; the pharmaceutical cost component incorporated the routine practice of splitting vials into prefilled syringes in hospital pharmacies. The model compared four nAMD monotherapies, Avastin, Eylea 2 mg, Eylea 8 mg and Vabysmo, as well as the common practice of switching treatment-resistant patients from Avastin to Eylea 2 mg. We derived injection frequencies from clinical trials (for monotherapies) or observational data (for switching) and conducted one-way sensitivity analyses to identify key cost drivers.
Results: Over 2 years, the switching regimen had the highest per-patient cost (146 722 NOK), followed by Eylea 2 mg (100 481 NOK), Vabysmo (93 207 NOK), Avastin (86 262 NOK) and Eylea 8 mg (68 738 NOK). Avastin had the lowest drug cost, but its high injection frequency increased non-drug costs. Sensitivity analyses showed that injection frequency strongly influenced total costs for high-priced drugs, while patient time had a substantial impact for Avastin.
Conclusion: In our model, longer-acting agents reduced injection frequency and decreased overall treatment costs. These findings suggest that adopting longer-acting monotherapy could improve cost-efficiency in long-term nAMD management in Norway.
Keywords: cost minimization analysis; costs; intravitreal therapy; neovascular age‐related macular degeneration.
© 2026 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.