Cost Analysis of Anti-VEGF With Laser Photocoagulation in the Treatment of Retinopathy of Prematurity at an Academic Referral Center

Purpose: To evaluate the financial impact of monotherapy with intravitreal (IVT) bevacizumab and compare it with a combined approach of panretinal photocoagulation (PRP) and IVT bevacizumab for the treatment of retinopathy of prematurity in the United States. Methods: Data from 122 eyes of 71 infants initially treated with IVT bevacizumab monotherapy (Group 1) or IVT bevacizumab with PRP (Group 2) were collected. The direct cumulative costs of examinations, PRP, IVT bevacizumab, examinations under anesthesia, fundus photography, and fluorescein angiography were reported. The costs for each service or procedure were extrapolated from Centers for Medicare & Medicaid Services. The physician, facility, and total costs of each service were calculated for both groups when using Avastin vials or bottles. Results: Following the ideal American Academy of Pediatrics guidelines, the mean number of inpatient and outpatient examinations for Group 1 infants was 12.10 and 10.74, respectively, and was 9.97 and 2.12 for Group 2 infants, respectively. The average cost billed for all examinations and procedures was $5045.34 in Group 1 and $4349.92 in Group 2 when using Avastin vials. The largest share of total treatment costs in Group 1 was from subsequent inpatient visits, amounting to $1164.04 (23.07%). In contrast, the largest share of costs in Group 2 was for PRP, which totaled $1656.13 (38.07%). Conclusions: This study highlights that, compared with combined treatment of IVT bevacizumab and PRP, the direct cost of treating infants with IVT bevacizumab monotherapy is marginally increased and requires significantly more visits.