Costs and benefits of bevacizumab vial sharing for the treatment of retinal diseases

• Main Authors: Sávio Lima Sodré, Italo Antunes França Barbosa, Israel Emiliano Pacheco, Felipe de Queiroz Tavares Ferreira, Milton Agrizzi David, Mauricio Abujamra Nascimento, Carlos Eduardo Leite Arieta, Jose Paulo Cabral de Vasconcellos
• Format: Article
• Language: English
• Published: BMC 2019-09-01
• Series: BMC Public Health
• Subjects: Anti-vascular endothelial growth factor; Bevacizumab; Repackaging; Vial sharing; Public hospitals; Brazil
• Online Access: http://link.springer.com/article/10.1186/s12889-019-7562-y

Abstract Background Antiangiogenic therapy has proved to be an important therapeutic tool for many retinal vascular diseases; however, its availability is limited in developing countries. This study sought to describe the bevacizumab vial sharing process and to evaluate the impact of this repackaging system on the costs incurred in a Brazilian public hospital. Method This retrospective study compared the number and costs of intravitreal antiangiogenic injections approved via court order in the first year of the study (2015) to the number and costs of the bevacizumab injections provided through the use of vial sharing in the second year of the study (2016). Vial sharing consists of the traditional process used to repackage bevacizumab; in this case, however, the drug samples used were the residual volume from the preparation of bevacizumab for oncology patients. The hospital adhered to the guidelines established by the Brazilian Health Surveillance Agency (ANVISA). Results In the first year of the study and using medication obtained through court orders, 550 intravitreal injections were performed in the ophthalmology ambulatory care center. Based on local pricing tables, the total cost of the medication was BRL$1,036,056.25 (USD$267,546.58), and the average cost of each application was BRL$1883.74 (USD$486.45). In the second year of the study, 1081 intravitreal applications were performed at the same hospital using doses obtained through bevacizumab vial sharing. The total cost was BRL$21,942.49 (USD$5663.30) and the per-unit cost was BRL$20.30, or USD$5.23 (a savings of 97.88%). Conclusion This study found that bevacizumab vial sharing led to a significant reduction in public health care costs associated with antiangiogenic treatment and increased the availability of the drug to public health care patients. These results can be extrapolated to other types of drugs and health care systems.