How much could an approved bevacizumab actually save?
The main economic advantage of bevacizumab is its low drug price, but the total cost also depends on how often it must be injected. A 2024 cost-effectiveness analysis in Peru compared four anti-VEGF drugs for wet AMD and diabetic macular edema, and found that faricimab was the least expensive overall because it is given every 16 weeks, versus more frequent dosing for bevacizumab [1]. Over the full treatment course, faricimab saved US$2,823 per patient compared to bevacizumab—about 51% of the payer's cost—but in the first year, bevacizumab was cost-effective against faricimab because faricimab requires extra loading doses [1]. This means an approved bevacizumab could lower upfront costs, but if it requires more frequent injections than longer-acting drugs, the savings may shrink over time.
A 2026 systematic review of 22 cost-effectiveness studies found that bevacizumab and brolucizumab were frequently the most cost-effective options, offering comparable visual outcomes at lower costs than ranibizumab or aflibercept [4]. That review also noted that cost-effectiveness estimates are sensitive to model assumptions, such as time horizon and whether adverse events are included, so the real-world savings could vary [4]. In short, an approved bevacizumab would likely be a cost-saving option, but the magnitude depends on the treatment regimen and how long you look.
The catch: many patients may need to switch back
The biggest risk to the economic benefit is that bevacizumab may not work as well for everyone, especially in patients who have been on other anti-VEGF drugs. A Swedish study followed 67 eyes with chronic wet AMD that were switched from aflibercept to bevacizumab to cut costs; within 12 months, 64% of eyes had to switch back to aflibercept because of increased macular edema (fluid in the retina) or reduced visual acuity [2]. Most of those switches happened quickly—24% after just one bevacizumab injection and 67% after four or fewer [2]. This suggests that for a large subset of patients, the savings from using bevacizumab would be offset by the need to resume the more expensive drug, plus the extra clinic visits and monitoring.
The same study found that overall visual acuity at 12 months was not significantly different from baseline, but that was only because patients who worsened were switched back [2]. If an approved bevacizumab were used as a first-line treatment, the response might be better, but the evidence here is about switching, not initial therapy. The takeaway: an approved bevacizumab could save money, but only if patients respond well; for those who don't, the savings evaporate.
Can we predict who will need more injections?
To make the economics work, it would help to know which patients are likely to need many injections, because that drives cost. A machine learning study using data from the CATT trial (a large US trial comparing ranibizumab and bevacizumab) found that it is possible to predict, after the first 12 weeks of treatment, whether a patient will need few (≤8) or many (≥19) injections over two years [3]. The best model achieved an accuracy (area under the curve) of 0.77–0.82, meaning it could correctly identify high- and low-need patients about 80% of the time [3]. Key predictors included fluid on optical coherence tomography, lesion characteristics, and how the patient responded in the first three months [3].
This kind of prediction could help clinicians choose the most cost-effective drug for each patient—for example, using bevacizumab for those likely to need few injections, and reserving longer-acting drugs for those who need many. However, the study was based on trial data and needs validation in real-world settings before it can guide routine practice [3]. Still, it points to a future where treatment economics could be personalized, making an approved bevacizumab more viable.
About These Sources
This answer is built on 5 peer-reviewed studies — published from 2022 to 2026, 3 from 2024 or later, 1 in Q1 journals — selected as the most relevant from 5 studies that passed quality screening, drawn from 66 papers retrieved from a database of over 500 million.
Sources used in this answer
EE488 Cost-Effectiveness Analysis of Faricimab and Others Treatment Schemes for Diabetic Macular Edema and Age-Related Macular Degeneration
A 2024 cost-effectiveness analysis in Peru found that faricimab was the least expensive overall (saving US$2,823 vs bevacizumab), but in the first year bevacizumab was cost-effective against faricimab due to loading doses, and savings from switching to faricimab only appeared from the ninth year onward.
Switch of anti‐vascular growth factor agent from aflibercept to bevacizumab; outcomes in chronic wet age‐related macular degeneration
A Swedish retrospective cohort study of 67 eyes with chronic wet AMD switched from aflibercept to bevacizumab found that 64% needed to switch back within 12 months, mostly due to increased macular edema or reduced visual acuity, with 24% switching back after just one bevacizumab injection.
Evaluation of Multiple Machine Learning Models for Predicting Number of Anti-VEGF Injections in the Comparison of AMD Treatment Trials (CATT)
A machine learning study using CATT trial data (493 participants) found that models using data from the first 12 weeks could predict two-year anti-VEGF injection demand with AUCs of 0.77–0.82, identifying patients likely to need few (≤8) or many (≥19) injections.
Cost-Effectiveness of Vascular Endothelial Growth Factor Inhibitors in the Management of Wet Age-Related Macular Degeneration: A Systematic Review
A 2026 systematic review of 22 cost-effectiveness studies concluded that bevacizumab and brolucizumab were frequently the most cost-effective options for wet AMD, offering comparable visual outcomes at lower costs than ranibizumab or aflibercept, but estimates were sensitive to model assumptions.
Impact of repeated anti-VEGF injections on the corneal nerve plexus in patients with Wet-AMD
A 2025 study of 48 wet AMD patients found that repeated anti-VEGF injections (including bevacizumab) were associated with a decrease in corneal nerve fiber width, but no changes in corneal sensitivity or tear film, and no differences between agents, suggesting the treatment is generally safe for the ocular surface.