Vial Sharing for Bevacizumab in Treating Eye Disorders Reduces Costs, Increases Access

The anti—vascular endothelial growth factor (anti-VEFG) therapy bevacizumab (Avastin) is increasingly used off-label for the treatment of retinal disorders, especially in regions where the high cost of other anti-VEFG therapies, like ranibizumab or aflibercept, is of special concern.

Given that bevacizumab is available at a lower cost than these other therapies—and that biosimilar bevacizumab is becoming commercially available at an even lower list price in some territories—the question of how to optimize this agent’s use in ophthalmology is of particular interest for health systems in search of cost savings.

One recent study from Brazil described the way in which vial sharing and pharmacist-led repackaging of bevacizumab used in oncology brought down costs for a public hospital that treats patients with retinal diseases.

The paper’s authors obtained patient information from medical records between 2015 and 2017, and compared the medications used, the costs of the medications, and cost of medicines in the case of vial sharing for bevacizumab, which was implemented by the hospital in 2016. In the vial-sharing procedure, bevacizumab that is left over from treating patients with cancer is removed from its original packaging, divided into smaller doses, and repackaged in a manner that preserves quality and includes identifying information for use in the ophthalmology clinic.

In the first year of the study, 550 intravitreal injections were performed: 192 of these injections were of bevacizumab (at a total cost of BRL$248,033.28, or US$64,016.84), 347 were of ranibizumab BRL$755,321.84, US$194,946.92), and 11 were of aflibercept (BRL$32,701.13, US$8440.09).

In the second year, 1081 doses were performed using bevacizumab obtained through vial sharing, with an isolated cost of BRL$17,455.98, (US$4514.28). When costs for the cleanroom where the drug was repackaged and costs for personnel were included, the total cost of vial sharing was BRL$21,942.49 (US$5663.30).

Vial sharing for bevacizumab that would otherwise have been discarded yielded a 97.88% reduction in the total cost of a single year of intravitreal injections, as well as a 96.54% increase in the number of injections performed.

The authors of the study note that high-cost medication wastage is not only a problem for health systems like that of Brazil; in the United States, they point out, bevacizumab waste was estimated to be 9% in 2016.

Given the results of this study, write the authors, further research should be encouraged to evaluate the effects of repackaging high-cost drugs as a way to more effectively use healthcare resources.