For patients with age-related macular degeneration (AMD) using lower-cost drug therapies, home-based imaging to track treatment response between injections may never be truly cost-effective, a new modeling study suggested.

The research, presented at the American Society of Retina Specialists (ASRS) 2026 Annual Meeting in Montreal, analyzed the use of home-based optical coherence tomography (OCT) for patients on intravitreal injections for their condition. The device in question, SCANLY (Notal Vision, Inc.), was approved as a home device in 2024.

“From a payer perspective, home OCT is the most cost-neutral or least costly for people who are on high-cost agents getting very frequent injections, whereas those on lower-cost medications or already on extended treatment intervals may be less neutral to the healthcare system,” said Sean Berkowitz, MD, MBA, vitreoretinal surgery fellow at Cleveland Clinic in Cleveland. “This doesn’t count for patient or caregiver burden as well as clinical efficacy.”

Berkowitz and colleagues developed a cost model using data from published clinical studies of home OCT monitoring in patients with neovascular, or wet, AMD. The model used drug acquisition costs from the January 2026 Medicare Part B payment limits for four drugs: bevacizumab (Avastin), ranibizumab (Lucentis), aflibercept 2 mg and 8 mg (Eylea and Eylea HD), and faricimab (Vabysmo).

They evaluated how many injections would be required in a year to reach cost-effectiveness with home OCT. Bevacizumab and ranibizumab never reached cost-effectiveness with treatment intervals ranging from 4 to 26 weeks. Medicare reimbursed $88.75 for a 1.25-mg injection dose of bevacizumab, according to 2024 Medicare data, while a 0.5-mg injection of ranibizumab was reimbursed at $797, figures that do not include procedure costs.

The minimum number of injections per year required to reach cost-effectiveness for the more expensive agents ranged from six for aflibercept 8 mg to eight for the lower dose. Patients on faricimab would have to receive at least seven injections to reach cost neutrality with the home device. The lower dose of aflibercept cost $1650 in 2022, while the higher dose can run up to $2640, and faricimab reached $2068 for a 6-mg dose.

Dosing intervals for these drugs vary, from every 4 weeks for bevacizumab and ranibizumab to up to every 16 weeks for faricimab and aflibercept 8 mg.

“It may be most economically favorable to target patients on higher-cost agents who are receiving frequent injections for home OCT because injection-sparing benefits and recurring device fees dominate economic feasibility,” Berkowitz told Medscape Medical News. “This calculus may change as the fee schedule evolves and should account for patient and caregiver burden.”

Berkowitz and colleagues also estimated the 1-year cost differences between using the at-home device and standard office monitoring. Cost neutrality was only achieved with decreased injection intervals or reduced monthly costs of the device.

Christina Weng, MD, MBA, retina specialist and researcher at the Baylor College of Medicine in Houston, said during the discussion that as new investigative drugs extend treatment intervals to 6 months or even a year, home OCT could become more cost-effective.

“That’s where I think that natural marriage between home OCT technology and the way we treat patients really lies,” she said.

The model also analyzed how much time physicians would spend reviewing home OCT scans for 100 patients on a weekly basis.

“Every single scan per patient would require up to 21 hours per week,” Berkowitz said.

The cost model may be helpful to clinicians, said Manju Subramanian, MD, associate professor at Boston University Chobanian & Avedisian School of Medicine in Boston.

“Is this something like a home blood pressure system, for example?” she said. “Is it going to be one of those things where they’re going to check 10 times a day, and then they’re going to report back?” This could result in more burden for clinicians, Subramanian said.

Berkowitz reported no relevant financial relationships. Subramanian is a consultant to Regeneron. Weng reported being a consultant to Genentech, Novartis, and Regeneron.