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Anti-VEGF remains most expensive PBS drug

Anti-VEGF PBS drug

The Australian government spent $55 million more on anti-VEGF macular disease therapies in 2020-21 compared to the previous year, with aflibercept (Eylea) maintaining its title as the costliest subsided drug in the country.

The government spent $665 million on aflibercept (brand name: Eylea) and ranibizumab (brand name: Lucentis) combined last year, according to Australian Prescriber’s top 10 drugs based on Pharmaceutical Benefits Scheme (PBS)/Repatriation Pharmaceutical Benefits Scheme (RPBS) prescriptions from July 2020 – June 2021.

They were the only two eye therapies to appear on the list. In total, the government spent $444 million (not including rebates) on aflibercept to cover 364,800 prescriptions, making it the most expensive PBS treatment for a second consecutive year. That’s a 13% increase on last year’s $392 million (315,200 scripts).

For ranibizumab, which ranked eighth by cost, it paid $222 million for 190,300 prescriptions, up from $218 million for 190,126 injections in 2019-20.

Although the anti-VEGF therapies featured prominently in the top 10 drugs by cost, they did not feature in the top drugs by volume. That list was topped by the cholesterol-lowering rosuvastatin (14 million scripts) and atorvastatin (11 million scripts), as well as pantoprazole for stomach ulcers and gastroesophageal reflux disease (9 million scripts).

Asked why anti-VEGF therapies remained among the most heavily PBS-subsidised therapies, Macular Disease Foundation Australia (MDFA) told Insight it estimates there are 156,000 neovascular (wet) age-related macular degeneration patients (nAMD), 72,000 with diabetic macular oedema (DMO) and up to 135,000 with other vision-threatening macular diseases who could benefit from anti-VEGF therapies.

“Patients with wet AMD require regular and frequent treatment to reduce the risk of permanent vision loss and blindness. Treatment is not a cure, and while the current drugs are highly effective, patients typically receive between five to seven injections per year on an ongoing basis and will need to continue for the rest of their lives,” the organisation stated.

With few reimbursed treatments for macular diseases, MDFA said it is perhaps unsurprising they appear high on the PBS list of medications. However, more therapies are entering this space with brolucizumab (brand name: Beovu) PBS-listed last October, and a port delivery system for ranibizumab (brand name: Susvimo) and faricimab (brand name: Vabysmo), a bispecific anti-VEGF, currently under review for reimbursement in Australia.

With a considerable year-on-year increase in anti-VEGF use from 2019-20 to 2020-21, MDFA said it would be difficult to determine what directly led to this. However, with an ageing population, it estimates an additional 5,500 patients each year are diagnosed with nAMD and could benefit from anti-VEGF.

It also estimates about 55,000 nAMD patients currently receive anti-VEGF treatment. The increase (~10% per year) is in line with the combined increase in aflibercept and ranibizumab scripts.

Overall, MDFA said Australian ophthalmologists were quick to recognise the revolutionary nature of anti-VEGF treatments when they first became available 15 years ago and were pioneers in determining the most efficient treatment approach. It said Australia is recognised among the world’s best for the treatment and management of macular diseases, with patients supported by a robust healthcare system.

“The recent commitment by both major political parties ahead of the Federal election to reject the proposal to cut the Medicare rebate for intravitreal injections will see this reputation maintained,” MDFA said.

“Additionally, one new anti-VEGF treatment was recently listed for reimbursement and two more – which promise of longer intervals between treatments with the same efficacy – could enter the market soon, demonstrating Australia continues to benefit from new and innovative treatments.”

More reading

Anti-VEGF becomes most expensive drug on PBS – 2021

Federal election: PBS script savings regardless of who’s elected

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