Table 3.
Comparative anti-vascular endothelial growth factor (anti-VEGF) medications with the approved protocols and costs of the related drug therapies in the first year of therapy for wet AMD
| Drug (company) | Ranibizumab (Genentech; Novartis) | Bevacizumab (Genentech; Roche) | Aflibercept (Regeneron; Bayer) | Ziv-aflibercept (Bayer) |
|---|---|---|---|---|
| Molecular weight | 48 kDa | 149 kDa | 115 kDa | 115 kDa |
| Half-life (serum)23 | 4.75 days | 8.25 days | 18 days | 18 days |
| Half-life(vitreous) | 2.75 days24 | 4.9 days25 | 7.1 days23 | 7.1 days23 |
| Affinity to VEGF16523 | Kd 46 Pm* | Kd 58 Pm | Kd 0.49 Pm | Kd 0.49 Pm |
| Inhibit | VEGF-A | VEGF-A | VEGF-A; VEGF-B; PlGF | VEGF-A; VEGF-B; PlGF |
| Vial cost | £741† | £242.7‡ | £816§ | £295.7¶ |
| Cost per eye | £741 | £40† | £816 | £48 |
| Cost per year 1 | £8892 | £480 | £6528 | £384 |
| Vial dose and volume | 2.3 mg in 0.23 mL | 100 mg in 4 mL | 4 mg in 0.1 mL | 100 mg in 4 mL |
| AMD regimen | 0.5 mg monthly | 1.25 mg monthly | 2 mg monthly 3 times then bimonthly | 1.25 mg monthly 3 times then bimonthly |
| Injection volume | 0.05 mL | 0.05 mL | 0.05 mL | 0.05 mL |
| No. injections in year 1 | 12 | 12 | 8 | 8 |
Costs (in £=English pound) according to the British National Formulary edition 66.
*Affinity expressed as equilibrium dissociation constant (KD) in the picomolar (Pm) range.
†http://www.pmlive.com/pharma_news/novartis_nhs_price_lucentis_wet_amd_roche_avastin_402440 (accessed Jul 2014).
‡National Institute for Health and Care Excellence (NICE) technology appraisal guidance 242 (http://www.nice.org.uk/guidance/ta242/chapter/the-technologies) (accessed Jul 2014).
§NICE technology appraisal guidance 305 issued February 2014 (http://guidance.nice.org.uk/ta305).¶NICE technology appraisal guidance 617 issued March 2014 (http://guidance.nice.org.uk/TA/Wave0/617).
AMD, age-related macular degeneration; PlGF, placental growth factor.