Background Antiangioagenic drugs, ranibizumab, bevacizumab and the most recent one marketed, aflibercept, are the elected treatments of age related macular degeneration (AMD). These treatments are a heavy economic burden because of the growing number of patients diagnosed with AMD.

Purpose

1. To describe the process of developing 2 mg/0.05 mL sterile intravitreal aflibercept syringes to treat AMD refractory to bevacizumab and/or ranibizumab.

2. To assess the savings brought about by the implementation of this process.

Material and methods The pharmacy department prepares 2 mg/0.05 mL sterile intravitreal aflibercept syringes from 4 mg/0.1 mL aflibercept commercial vials in a horizontal laminar flow hood. The entire vial content is charged in a 2.5 mL sterile syringe, with an integrated filter needle. With a 1 mL sterile syringe (with 0.33 mm (29 G) needle incorporated and without free space) the necessary dose is loaded, absorbing aflibercept solution by the tip of the 2.5 mL syringe and without touching the needle on any surface to avoid damaging the bezel. The ready to use syringe must be perfectly flush and without bubbles. This was a retrospective study, from February 2015 to September 2015. Farmatools software was used to record the number of patients diagnosed with AMD refractory to bevacizumab and/or ranibizumab treated with aflibercept, and the cost of the dispensed aflibercept vials and syringes. Direct costs between the use of aflibercept syringes instead of vials was compared in order to calculate the savings per dose and the total savings.

Results Three ready to use aflibercept syringes are obtained from one commercial vial. A small volume of aflibercept remains in it, but not enough to prepare another syringe.

During the study period, 60 aflibercept syringes were prepared from 18 vials to treat 25 patients. Each syringe cost 191.17€; this meant a total cost of 11 470.20€. Each vial cost 644.54€. If the corresponding number of vials had been used, total cost would have been 38 672.40€. The savings per dose and total were 453.37€ and 27 202.20€, respectively.

Conclusion Preparation of ready to use aflibercept syringes provides greater accuracy and safety for the treatment of AMD refractory to bevacizumab and/or ranibizumab.

Cost savings are achieved with the optimisation of aflibercept commercial vials. The savings would be greater if more vials were optimised simultaneously, because the surplus could be used and more aflibercept syringes would be obtained.

No conflict of interest.