TABLE 2.
Cost Input for the Model
| Services | Rate | Cost per unit | CPT and HCPCS codes |
|---|---|---|---|
| Drug costs | |||
| Wholesale acquisitions cost | |||
| Ranibizumab 0.5 mg/0.05 mL | Manufacturer: 12, PRN: 6.9, T&E: 8, RWE: 7.23 | $1,950.00 | IBM Micromedex Red Book73 |
| Aflibercept 2 mg/0.05 mL | Manufacturer: 8.02, PRN: 5.1, T&E: 8, RWE: 7.04 | $1,850.00 | IBM Micromedex Red Book73 |
| Bevacizumab 1.25 mg/0.05 mL | Manufacturer: 12, PRN: 7.7, T&E: 8.9, RWE: 6.91 | $73.20 | IBM Micromedex Red Book73 |
| Brolucizumab 6 mg/0.05 mL | Manufacturer: 7.01, PRN: 7.13, T&E: 7.13, RWE: 5.55 | $1,850.00 | IBM Micromedex Red Book73 |
| Average sales price | Same rate as used for WAC | ||
| Ranibizumab 0.5 mg/0.05 mL | $1,376.00 | HCPCS J277880 | |
| Aflibercept 2 mg/0.05 mL | $1,826.00 | HCPCS J017880 | |
| Bevacizumab 1.25 mg/0.05 mL | $73.00 | IBM Micromedex Red Book73 | |
| Brolucizumab 6 mg/0.05 mL | $1,872.00 | HCPCS J017980 | |
| Administration costs | |||
| Cost of intravitreal injection in 1 eye | Based on the treatment regimen | $114.20 | CPT 6702874 |
| Cost of intravitreal injection in both eyes (1.5x the cost of 1 eye) | — | $171.30 | Medicare multiple surgery payment guidelines75,76 |
| Physician visits | |||
| Cost of an initial office visit | 1 | $169.57 | CPT 9920474 |
| Cost of subsequent office visit | PRN is monthly; other regimens rate is determined by dosages | $128.39 | CPT 9201474 |
| Lab and disease monitoring costs | |||
| Optical coherence tomography at each visit | PRN is monthly; other regimens rates is same as their dosages | $41.18 | CPT 9213474 |
| Fluorescein angiography, at initial evaluation | 1 | $127.70 | CPT 92235,74 rate assumed to be one for the first visit |
| Cost of fluorescein angiography involving fellow eye (2x the cost of 1 eye) | $255.40 | Assumed based on a study Yu et al (2021)67 | |
CPT = Current Procedural Terminology; HCPCS = Healthcare Common Procedure Coding System; PRN = pro re nata; RWE = real-world evidence; T&E = treat and extend; WAC = wholesale acquisitions cost.