Real-world cost-effectiveness of anti-VEGF monotherapy and combination therapy for the treatment of polypoidal choroidal vasculopathy.

Journal Article (Journal Article)


For patients with polypoidal choroidal vasculopathy (PCV), intravitreal anti-vascular endothelial growth factor (anti-VEGF) combination therapy has been shown to be cost-saving relative to monotherapy in a clinical trial setting. However, whether this also applies to real-world settings is unclear. We aim to compare the real-world functional outcomes and cost-effectiveness of intravitreal anti-VEGF combination therapy relative to monotherapy, to investigate whether combination therapy is truly cost-saving.


We used a Markov model to simulate a hypothetical cohort of PCV patients treated at Singapore National Eye Centre. Model parameters were informed by coarsened exact matched estimates of a two-year retrospective study of patients who initiated treatment in 2015. Treatment options included intravitreal aflibercept, bevacizumab, or ranibizumab, as monotherapy or in combination with full-fluence verteporfin photodynamic therapy.


The two-year logMAR letters gains were significant for combination therapy ( + 10.6, P = 0.006) but not monotherapy (-2.2, P = 0.459). Over 20 years, a PCV patient would cost the health system SGD 48,790 under monotherapy and SGD 61,020 under combination therapy. Quality-adjusted life-years (QALYs) were estimated to be 7.41 for monotherapy and 7.80 for combination therapy. The incremental cost-effectiveness ratio of combination therapy was SGD 31,460/QALY, which is less than the common willingness-to-pay threshold of per capita gross domestic product of Singapore (SGD 88,990/QALY). Sensitivity analysis showed that combination therapy remained incrementally cost-effective, but not cost-saving.


Our study shows that combination therapy is good value for money but is likely to increase costs when applied in real-world settings.

Full Text

Duke Authors

Cited Authors

  • Chay, J; Fenner, BJ; Finkelstein, EA; Teo, KYC; Cheung, CMG

Published Date

  • December 2022

Published In

Volume / Issue

  • 36 / 12

Start / End Page

  • 2265 - 2270

PubMed ID

  • 34811522

Pubmed Central ID

  • PMC9674616

Electronic International Standard Serial Number (EISSN)

  • 1476-5454

International Standard Serial Number (ISSN)

  • 0950-222X

Digital Object Identifier (DOI)

  • 10.1038/s41433-021-01856-9


  • eng