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Anti-VEGF becomes most expensive drug on PBS

The Australian government spent more than $610 million on anti-VEGF treatments during the past year, with aflibercept (Eylea) leapfrogging a hepatitis C drug to become the costliest subsidised drug for the first time.  

Aflibercept and ranibizumab (Lucentis) were the only two eye therapies to appear in Australian Prescriber’s top 10 drugs based on Pharmaceutical Benefits Scheme (PBS)/Repatriation Pharmaceutical Benefits Scheme (RPBS) prescriptions from July 2019 to June 2020.

In total, the government spent $392 million (not including rebates) on aflibercept to cover 315,200 prescriptions, making it the most expensive PBS treatment. For ranibizumab, which ranked seventh by cost, it paid $218 million for 190,126 injections.

The PBS listed price for anti-VEGF therapies is $1,042.89 (special pricing arrangements apply), with the general patient charge being $41.30.

The government spent $392 million on aflibercept in the year to June 2020.

Although the anti-VEGF therapies were among the most expensive, they weren’t the most prescribed overall. But prescriptions for both therapies rose considerably compared with the 2018/19 period, with aflibercept increasing by 25,700 and ranibizumab by 9,400.

Ms Dee Hopkins, CEO of the Macular Disease Foundation Australia, said it was difficult to determine what led to the increase.

“It could be due to more diabetic macular edema (DME) patients getting treated, it’s possible that age-related macular degeneration (AMD) is being better diagnosed and perhaps increased compliance. However, it is impossible to say if a higher proportion of those in need are being treated without further data,” she said.

The figures also capture a significant portion of the COVID-19 lockdown period when the MDFA raised concerned about the number of macular disease patients missing sight-saving intravitreal injections.

Dee Hopkins.

“With regard to COVID, intravitreal injections of anti-VEGF were prioritised as being medically essential, even during the early lockdown period (during the period of these statistics) so the impact may have been less than expected,” Hopkins said.

“Also scripts would have been written even if patients did not necessarily come for treatment in a timely fashion.”

Since 2007, when anti-VEGF treatments first became available on the PBS, Hopkins said Australia had become a world leader in the management of neovascular AMD, arguably delivering the world’s best outcomes.

“Australian ophthalmologists recognised very early the revolutionary, sight-saving nature of these treatments, and the Australian government was quick to appreciate this and provide reimbursement to patients,” she said.

The 10 most expensive drugs on the PBS last year. Source: Australian Prescriber

“Since anti-VEGF treatment was first listed on the PBS for wet AMD treatment, the Australian government has continued to support patients with other treatable types of macular disease by gradually expanding the indications for PBS reimbursements.”

Possible drugs that could be reimbursed in future include brolucizumab (Beovu), which is yet to be recommended for the PBS for nAMD, and ranibizumab for proliferative diabetic retinopathy, which obtained TGA approval in September.

Despite the significant costs to the taxpayer, Hopkins said the government had given no indication to reduce reimbursement for anti-VEGF treatments.

“What price can you put on saving sight? If this treatment was not available, it would result in higher costs in other areas of the health and welfare systems due to people losing their sight and becoming more dependent on government support. The access to publicly listed medicines in Australia is one of the best and most equitable in the world,” she said.

Other drugs in the top 10 most expensive were for cancer, various types of arthritis, osteoporosis, plaque psoriasis and anticoagulants. Sofosbuvir + velpatasvir, a drug for chronic hepatitis C infection, was the costliest drug in 2018/19 ($391 million), followed by aflibercept in second ($358 million). However, sofosbuvir + velpatasvir dropped to sixth place last year.

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