Beyond Cost: Faricimab as a Driver of Service Efficiency and Quality in Neovascular Age-Related Macular Degeneration Care

Neovascular age-related macular degeneration (nAMD) is a chronic, vision-threatening condition requiring ongoing anti-vascular endothelial growth factor (anti-VEGF) injections. As the population ages and the demand for eye care rises, capacity-constrained healthcare systems struggle to deliver timely treatment. In the UK, many patients experience delays, increasing the risk of irreversible visual loss. Therapies with extended dosing intervals, such as faricimab, may reduce treatment burden and improve care quality.

A microsimulation model was developed representing a hypothetical UK National Health Service (NHS) retinal clinic over 5 years, comparing service and cost outcomes for two nAMD therapies. The study included a pairwise comparison (base case) of faricimab versus biosimilar aflibercept 2 mg, and a future market analysis comparing contrasting payer strategies, 'treatment choice' (75% faricimab market share) versus 'strict biosimilar mandate' (75% biosimilar market share). Outcomes included quality care delivery metrics, service utilisation, NHS provider costs, and litigation costs. Sensitivity analyses were performed to explore uncertainty.

Across all scenarios, faricimab reduced injection frequency, clinic visits, and treatment delays compared with biosimilar aflibercept 2 mg. In the base case, faricimab reduced delayed visits by 97.4% (158 vs 6171) and improved the key quality care delivery metric of loading phase completion by 54.1 percentage points (95.8% vs 43.7%). Faricimab was also associated with lower acquisition costs, with additional savings arising from reduced service and litigation-related costs. In the future market analysis, a treatment choice policy resulted in improved operational and quality-of-care metrics compared with a strict biosimilar mandate, resulting in lower total costs.

In capacity-constrained settings, more durable options like faricimab can unlock operational capacity, enabling health systems to treat more patients, reduce delays, and more effectively achieve quality standards. These improvements not only help preserve vision but also generate economic value, as operational efficiencies can reduce service and litigation costs, complementing potential reductions in acquisition costs.