Using Post-market Utilisation Analysis to Support Medicines Pricing Policy: An Australian Case Study of Aflibercept and Ranibizumab Use

  • Anna Kemp-Casey
  • Nicole Pratt
  • Emmae Ramsay
  • Elizabeth E. Roughead
Original Research Article



To describe how post-market utilisation analysis in Australia informs cost-effectiveness assessment and pricing decisions, using aflibercept and ranibizumab as case studies.


Pharmaceutical claims were used to identify initiators of aflibercept and ranibizumab in the year after aflibercept-listing (December 2012), and ranibizumab initiators in the year before aflibercept listing. The dispensing rates for each cohort were calculated, and their demographic and clinical characteristics compared using Kruskal–Wallis tests.


Aflibercept and ranibizumab each accounted for half the age-related macular degeneration market following ranibizumab listing. Aflibercept initiators had similar dispensing rates to ranibizumab initiators in the pre- and post-aflibercept era (~ three scripts during the first 90 days, and eight to nine scripts during the following 12 months). All cohorts were similar in terms of their age, sex, residential aged-care status and geographic remoteness, and no differences were observed in their overall co-morbidity scores and history of thromboembolic events.


Contrary to clinical trial protocols, post-market utilisation research for ranibizumab and aflibercept demonstrates equivalent use in practice in terms of dose frequency, and the demographic and clinical characteristics of initiators. This supports Australia’s decision to pay the same price for each rather than giving a premium to aflibercept. Many other countries are likely overpaying for aflibercept if their utilization patterns are similar to Australia’s, and could benefit from incorporating routine utilisation assessment.



We are grateful to Dr Alicia Segrave, DUSC Secretary, for comments on an earlier draft of this paper. This work was supported by an Australian Government National Health and Medical Research Council Centre of Research Excellence in Post-Marketing Surveillance of Medicines and Medical Devices grant (GNT1040938).The funding organization had no role in the design or conduct of this research.

Data Availability Statement

This study involved the analysis of existing health service data collected by the Australian Department of Veterans’ Affairs. These data are only available to researchers who have received ethical and scientific approval. Further information about data access is available at

Author Contributions

EER and AKC conceived the study. EER, NP and ER assisted with the acquisition of data. AKC drafted the manuscript. ER performed the statistical analyses. NP aided with data interpretation and critically reviewed the statistical content of the manuscript. All authors read, critically reviewed and approved the final manuscript.

Compliance with ethical standards

Ethics approval was obtained from the University of South Australia Human Research Ethics Committee (reference, P099/10) and the Department of Veterans’ Affairs Human Research Ethics Committee (reference, E010/010). This work was supported by an Australian Government National Health and Medical Research Council Centre of Research Excellence in Post-Marketing Surveillance of Medicines and Medical Devices grant (GNT1040938).The funding organization had no role in the design or conduct of this research. NP and EER are current members, and AK is a former member, of the Drug Utilisation Sub Committee of the Pharmaceutical Benefits Advisory Committee. The views expressed in this paper do not necessarily reflect the views of the Drug Utilisation Sub Committee or the Australian Department of Health. ER has no conflicts to declare.


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical SciencesUniversity of South AustraliaAdelaideAustralia

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