Impact of faricimab and high-dose aflibercept on treatment demand in a tertiary ophthalmic centre in Norway.

PURPOSE: To evaluate the impact of introducing faricimab and high-dose aflibercept on intravitreal injection (IVI) demand and treatment costs for retinal diseases in a large tertiary retina centre. METHODS: This retrospective longitudinal registry study included all anti-VEGF treatment episodes at Oslo University Hospital, Norway, between 2021 and 2025. Annual injection volumes, treatment patterns, and costs were assessed following the introduction of faricimab (2023) and high-dose aflibercept (2025). High-dose aflibercept was generally administered at 50 μL (5.7 mg). Costs components were estimated using a health-economic model. RESULTS: A total of 142 960 treatment episodes comprising 169 700 IVIs in 7865 patients (mean age 75.5 years, 56.6% female) were included. Macular degeneration was the most common diagnosis. Treated patients increased from 4148 in 2021 to 4982 in 2025. Injections increased from 31 780 in 2021 to a peak of 35 508 in 2024 before declining to 33 696 in 2025, while mean injections per patient decreased from 7.7 to 6.8. Following its introduction in 2023, faricimab became the most used agent. Off-label bevacizumab proportion decreased from 50.6% in 2021 to 30.0% in 2025. Mean treatment cost per patient increased from NOK 38029 in 2021 to NOK 40187 in 2025 (+5.7%), while total treatment costs increased from NOK 158 million to NOK 200 million (+26.9%). CONCLUSIONS: The introduction of faricimab and high-dose aflibercept was associated with reduced per-patient treatment intensity, while the treated population continued to increase. Longer-acting anti-VEGF drugs may reduce pressure on retinal services by lowering injection frequency; however, their introduction was associated with higher overall costs.