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Original Investigation
January 10, 2019

Comparison of Ophthalmic Medication Prices Between the United States and Australia

Author Affiliations
  • 1Vitreous Retina Macula Consultants of New York, New York
  • 2LuEsther T. Mertz Retina Research Foundation, New York, New York
  • 3Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston
  • 4Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
  • 5Department of Ophthalmology, University of Yamanashi, Yamanashi, Japan
  • 6Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
  • 7Lions Eye Institute, Nedlands, Australia
  • 8Department of Ophthalmology, Sir Charles Gairdner Hospital, Nedlands, Australia
  • 9Northern California Retina Vitreous Associates, Mountain View
  • 10Department of Ophthalmology, University of California, San Francisco
  • 11Roski Eye Institute, University of Southern California, Los Angeles
  • 12Optigo Biotherapeutics, Vancouver, British Columbia, Canada
  • 13Department of Ophthalmology, New York University, New York, New York
  • 14New York University Ophthalmology Associates, New York, New York
JAMA Ophthalmol. Published online January 10, 2019. doi:10.1001/jamaophthalmol.2018.6395
Key Points

Question  Are relatively expensive prices for adalimumab, ranibizumab, or aflibercept changing in different ways in high-income nations with the highest and lowest spending on health care?

Findings  In this comparison of prices paid by government entities in the United States and Australia for ophthalmic medicines, the estimated annual decrease in price from 2013 to 2017 for adalimumab, ranibizumab, or aflibercept was greater in Australia than in the United States. For example, the decrease in price for aflibercept was −1.5% in the United States compared with −16.9% in Australia, a difference of 15.4%.

Meaning  The prices of adalimumab, ranibizumab, and aflibercept had larger declines from 2013 to 2017 in Australia than the United States despite similar or higher initial prices.

Abstract

Importance  Health care prices may drive differences in health care costs across high-income nations. Adalimumab, ranibizumab, and aflibercept are high-cost medications in the United States and Australia. A comparison of their prices over time may elucidate how ophthalmic medication prices contribute to health care costs.

Objective  To compare changes in the prices of adalimumab, ranibizumab, and aflibercept in the United States and Australia, the highest and lowest spenders on health care, respectively, among high-income nations.

Design, Setting, and Participants  This retrospective price comparison study examined prices paid by government entities in the United States (Medicare) and Australia (Pharmaceuticals and Benefits Scheme). The analysis and data collection were conducted from March 28 to May 4, 2018, in accordance with guidelines set by the International Society for Pharmacoeconomics and Outcomes Research Task Force on Good Research Practices and prior published studies. No human participants or related data were included in this study.

Exposures  The change in mean prices of adalimumab, ranibizumab, and aflibercept in the United States and Australia.

Main Outcomes and Measures  Initial, final, and change in medication price annually from 2013 to 2017 in inflation-adjusted 2017 US dollars.

Results  The mean prices (US dollar prices unadjusted for inflation) in 2013 and 2017 in the United States were $1114 ($1053) and $1818 ($1818), respectively, for adalimumab; $2102 ($1988) and $1904 ($1904), respectively, for ranibizumab; and $2074 ($1961) and $1956 ($1956), respectively, for aflibercept. The mean (Australian dollar prices unadjusted for inflation) 2013 and 2017 prices in Australia were $1854 (A $1797) and $1206 (A $1574), respectively, for adalimumab; $2157 (A $2090) and $972 (A $1268), respectively, for ranibizumab; and $2030 ($1967) and $996 ($1300), respectively, for aflibercept. The estimated annual change in price for adalimumab was +12.8% (95% CI, 9.1%-16.5%) in the United States compared with −11.1% (95% CI, −15.0% to −7.1%) in Australia, a difference of 23.9% per year (95% CI, 19.7%-28.0%; P < .001). The annual change in price for ranibizumab was −2.6% (95% CI, −3.9% to −1.3%) in the United States compared with −18.5% (95% CI, −29.3% to −7.8%) in Australia, a difference of 15.9% per year (95% CI, 7.6%-24.2%; P = .003). The annual change in price for aflibercept was −1.5% (95% CI, −2.2% to −0.7%) in the United States compared with −16.9% (95% CI, −25.1% to −8.6%) in Australia, a difference of 15.4% (95% CI, 9.1%-21.8%; P = .001).

Conclusions and Relevance  Results of this study indicate that the prices of adalimumab, ranibizumab, and aflibercept significantly decreased during the past 5 years in Australia compared with the United States. These data do not indicate why these differences are noted or what actions might affect future pricing in either country.

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