Costs and benefits of bevacizumab vial sharing for the treatment of retinal diseases

Abstract

Background Antiangiogenic therapy has proved to be an important therapeutic tool for many retinal vascular diseases; however, its availability is limited in developing countries. This study sought to describe the bevacizumab vial sharing process and to evaluate the impact of this repackaging system on the costs incurred in a Brazilian public hospital. Method This retrospective study compared the number and costs of intravitreal antiangiogenic injections approved via court order in the first year of the study (2015) to the number and costs of the bevacizumab injections provided through the use of vial sharing in the second year of the study (2016). Vial sharing consists of the traditional process used to repackage bevacizumab; in this case, however, the drug samples used were the residual volume from the preparation of bevacizumab for oncology patients. The hospital adhered to the guidelines established by the Brazilian Health Surveillance Agency (ANVISA). Results In the first year of the study and using medication obtained through court orders, 550 intravitreal injections were performed in the ophthalmology ambulatory care center. Based on local pricing tables, the total cost of the medication was BRL$1,036,056.25 (USD$267,546.58), and the average cost of each application was BRL$1883.74 (USD$486.45). In the second year of the study, 1081 intravitreal applications were performed at the same hospital using doses obtained through bevacizumab vial sharing. The total cost was BRL$21,942.49 (USD$5663.30) and the per-unit cost was BRL$20.30, or USD$5.23 (a savings of 97.88%). Conclusion This study found that bevacizumab vial sharing led to a significant reduction in public health care costs associated with antiangiogenic treatment and increased the availability of the drug to public health care patients. These results can be extrapolated to other types of drugs and health care systems.

Age-related macular degeneration and resource utilization in the Brazilian public healthcare system: a real-world retrospective study

“…The current guideline recommends vial sharing for the AMD treatment, which was found to represent a cost saving for the system, and consequently increasing the availability of the drug for patients treated at the public system [ 10 , 19 , 20 ]. We found a low annual cost of antiangiogenic treatment per patient, that mainly reflects the low number of injections performed per patient, different from the 12 injections per patient estimated in previous study [ 10 ].…”

Impact of the COVID-19 pandemic on patients receiving intravitreal injections

“…Anti-VEGF drugs are expensive and require repeated injections to maintain their therapeutic effects [25]. Usually, patients who have indications for this therapy require more than one injection.…”

“…Adjusting IVI rules to ease medical burdens, improve patient compliance and improve doctor-patient relationships requires attention. To maximize the use of leftover medication, some studies have investigated the feasibility and safety of repackaging the leftover intravitreal anti-VEGF agent to reduce the waste of public resources and patients' expenses [20]. In addition, another study provided a novel compounding method that split anti-VEGF biologics from single vials into multiple prefilled silicone oil-free syringes to improve the synthesis and storage of compounding drugs [28].…”

“…The security and economic benefit of splitting vials into prefilled syringes or repackaging the remaining medication for IVIs has been extensively studied by foreign groups [20][21][22]. These strategies showed a favorable application prospect.…”

Patient Safety in Ophthalmology

“…On the other hand, in order to reduce the costs, the drug needs to be repackaged for intravitreal injections by the local pharmacy. This action increases the risks of contamination, and therefore protocols and guidelines which stress the need of asepsis during syringe preparation have been made available [92].…”