Ocular diseases such as AMD, DME, and RVO have a significant burden on health systems. In daily clinical practice, Jordan faces significant constraints and resource shortages, making the economic burden of treating these retinal diseases a significant concern. The current investigation aimed to assess the budget impact and expanded access of switching to ranibizumab’s biosimilar for the management of retinal diseases in both guideline-based and real-world practice in Jordan. The four-year BIA showed that switching to the biosimilar could save between 6.9 and 21.2 million JOD compared with continuing other therapies. The cost reduction observed can help the health system manage the growing number of patients with retinal diseases without increasing the total budget. Moreover, adopting the biosimilar would allow more patients to receive therapy under the same financial resources. The results of this BIA suggest that the introduction of ranibizumab’s biosimilar is a practical and affordable approach.

The findings of this BIA are consistent with international and regional evidence (Brown et al., 2020; Carrasco et al., 2020; Dakin et al., 2014; El-Dahiyat & Eljilany, 2020; Hernandez et al., 2018; Holekamp et al., 2020; Izidoro et al., Impacto orçamentário da incorporação de medicamentos para tratamento em segunda linha do edema macular diabético no SUS sob a perspectiva da Secretaria de Estado de Saúde de Minas Gerais, Brasil./2019; Ross et al., 2016; Samacá-Samacá et al., 2025; Stein et al., 2014). Reports have shown that the cost of anti-VEGF therapy can reduce treatment expenditure without compromising clinical outcomes. For instance, in the United Kingdom, Dakin and colleagues demonstrated that ranibizumab and bevacizumab achieved comparable improvements in visual acuity, with lower-priced bevacizumab leading to marked savings (Dakin et al., 2014). The results of this study highlight the economic importance of using equally effective but less costly options. A study conducted in the United States by Stein et al. reported that ranibizumab was not cost-effective compared with bevacizumab for nAMD (Stein et al., 2014). On the other hand, Heier et al. confirmed that all three major anti-VEGF agents, namely aflibercept, ranibizumab, and bevacizumab, provided similar visual benefits in patients with DME (Heier, Bressler, et al., 2016). This information reinforces that price rather than efficacy largely determines the economic burden of anti-VEGF therapy.

Real-world evaluations from other markets have also confirmed that economic efficiencies can be achieved without sacrificing outcomes. A study in France found both aflibercept and ranibizumab to be cost-effective in routine practice. These results were largely influenced by dosing frequency and acquisition cost (Carrasco et al., 2020). Similarly, Samacá-Samacá et al. showed that market competition and introduction of biosimilars such as faricimab resulted in major national budget savings while maintaining efficacy (Samacá-Samacá et al., 2025). These studies support that introducing a ranibizumab biosimilar in Jordan follows a global movement toward affordable retinal treatment. This effort ensures positive patient outcomes and reduces overall healthcare spending.

From a regional perspective, adopting Ranibizumab’s biosimilar in Jordan is supported by similar findings from other Middle Eastern and middle-income healthcare systems. A recent Saudi Arabian study by El-Dahiyat and Eljilany showed that substituting aflibercept for ranibizumab could achieve 9% to 51% cost savings across retinal indications (El-Dahiyat & Eljilany, 2020). This result surely demonstrates how pricing competition can significantly reduce expenditure (El-Dahiyat & Eljilany, 2020). Moreover, a Brazilian study estimated that public sector adoption of lower-cost anti-VEGF agents could reduce total expenditures for DME management by nearly one-half (Izidoro et al., Impacto orçamentário da incorporação de medicamentos para tratamento em segunda linha do edema macular diabético no SUS sob a perspectiva da Secretaria de Estado de Saúde de Minas Gerais, Brasil./2019).

The consistent findings across international and regional studies suggest that incorporating ranibizumab’s biosimilar into national procurement systems represents a timely and evidence-based policy decision. For Jordan, the anticipated budget relief could be reinvested to improve screening, increase treatment, and improve overall ophthalmic services in public hospitals. Comparable results from Colombia and France further suggest that the availability of biosimilars and newer agents creates a competitive environment that ultimately benefits health systems through lower cost and increasing treatment opportunities for more patients (Carrasco et al., 2020; Samacá-Samacá et al., 2025). The successful implementation of biosimilar therapy, however, will depend on coordinated regulatory oversight, clinician education, and transparent procurement processes. Validating and improving these findings in the Jordanian context will require ongoing observation of clinical outcomes, patient satisfaction, and real-world utilization after biosimilar adoption.

This analysis has some limitations that should be considered. First, the model relied on secondary data rather than patient-level cost or utilization data. Variations in clinical practice patterns and injection frequency may influence actual expenditures. The analysis assumed therapeutic equivalence of treatments based on evidence from large comparative trials. Differences in adherence, dosing intervals, and physician preferences may affect treatment outcomes. The model did not include indirect costs such as productivity loss or caregiver burden. Finally, the projections represent short-to-medium-term estimates. Continuous monitoring of real-world utilization, clinical outcomes, and patient satisfaction following biosimilar adoption will be important to validate and refine these findings in the Jordanian context.