The frequency and costs of intravitreal therapy agents in retinal diseases
Abstract
Background: The aim of this study is to analyze the numbers and the economic burden of intravitreal anti-VEGF agents and intravitreal dexamethasone (IVD) implants administered to patients with diabetic retinopathy (DR), age-related macular degeneration (AMD) and retinal vein occlusion (RVO).
Material and methods: The retrospective case-control study included 1525 patients diagnosed with DME, neovascular AMD and RVO, and received intravitreal anti-VEGF and IVD between January 2016 and December 2018. Intravitreal anti-VEGF administration was performed within the framework of the Pro Re Nata (PRN) regimen. The prices of anti-VEGF agents and IVDs were calculated on the average of the prices in the relevant year.
Results: The total number of intravitreal injections in 3 years was 5864. During the 3-year follow-up, on average,
ranibizumab (Lucentis) was applied 3.56 ± 2.25 times, alfibercept (Eylea) was applied 3.31 ± 2.16 times, and IVD
(Ozurdex) was applied 1.70 ± 0.83 times. The anti-VEGF numbers in 2016, 2017 and 2018 were 1997, 1801, 2066,
respectively. In total, the 3-year drug cost was 3,587,812.44 USD.
Conclusions: The economic burden of intravitreal anti-VEGF and IVD treatment for retinal diseases is so important to developing countries such as Turkey. The economic burden created by anti-VEGF agents and IVDs in Turkey will reduce in a serious sense, and the legal concerns of physicians will decrease thanks to the decision taken by the Turkish Medicines and Medical Devices Agency (TMMDA).
Keywords: retinal diseasesanti-VEGFeconomic burdendiabetic retinopathyage-related macular degenerationretinal vein occlusion
References
- Bourne R, Stevens G, White R, et al. Causes of vision loss worldwide, 1990–2010: a systematic analysis. Lancet Glob Health. 2013; 1(6): e339–e349.
- Li JQ, Welchowski T, Schmid M et al. Retinal Diseases in Europe 2017. https://www.euretina.org/downloads/EURETINA_Retinal_Diseases.pdf (2017).
- Cai S, Bressler NM. Aflibercept, bevacizumab or ranibizumab for diabetic macular oedema: recent clinically relevant findings from DRCR.net Protocol T. Curr Opin Ophthalmol. 2017; 28(6): 636–643.
- Hanhart J, Rozenman Y. Comparison of Intravitreal Ranibizumab, Aflibercept, and Dexamethasone Implant after Bevacizumab Failure in Macular Edema Secondary to Retinal Vascular Occlusions. Ophthalmologica. 2017; 238(1-2): 110–118.
- Kovach JL, Schwartz SG, Flynn HW, et al. Anti-VEGF Treatment Strategies for Wet AMD. J Ophthalmol. 2012; 2012: 786870.
- Cai S, Bressler N. Aflibercept, bevacizumab or ranibizumab for diabetic macular oedema. Current Opinion in Ophthalmology. 2017; 28(6): 636–643.
- Chakravarthy U, Harding SP, Rogers CA, et al. IVAN Study Investigators. Ranibizumab versus bevacizumab to treat neovascular age-related macular degeneration: one-year findings from the IVAN randomized trial. Ophthalmology. 2012; 119(7): 1399–1411.
- Erie JC, Barkmeier AJ, Hodge DO, et al. High Variation of Intravitreal Injection Rates and Medicare Anti-Vascular Endothelial Growth Factor Payments per Injection in the United States. Ophthalmology. 2016; 123(6): 1257–1262.
- Baker-Schena L. Expensive Drugs. Eye Net Mag. 2017: 39–44.
- Ross EL, Hutton DW, Stein JD, et al. Diabetic Retinopathy Clinical Research Network. Cost-effectiveness of Aflibercept, Bevacizumab, and Ranibizumab for Diabetic Macular Edema Treatment: Analysis From the Diabetic Retinopathy Clinical Research Network Comparative Effectiveness Trial. JAMA Ophthalmol. 2016; 134(8): 888–896.
- Turpcu A, Wilson K, Huang A et al. Injection frequency and costs of anti-vegf treatments for neovascular age-related macular degeneration, retinal vein occlusion, and diabetic macular Eedema. Value Heal 2015; 18(3): A180. http://linkinghub.elsevier.com/retrieve/pii/S1098301515011018.
- Sosyal Güvenlik Kurumu. Sosyal Güvenlik Kurumu Sağlık Uygulama Tebliği. Sosyal Güvenlik Kurumu Sağlık Uygulama Tebliği. 2018. http://www.sgk.gov.tr/wps/portal/sgk/tr/kurumsal/merkez-teskilati/ana_hizmet_birimleri/gss_genel_mudurlugu/anasayfa_duyurular/guncel_sut_28122018.
- Schmidt-Erfurth U, Chong V, Loewenstein A, et al. European Society of Retina Specialists. Guidelines for the management of neovascular age-related macular degeneration by the European Society of Retina Specialists (EURETINA). Br J Ophthalmol. 2014; 98(9): 1144–1167.
- Lee R, Wong TY, Sabanayagam C. Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss. Eye Vis (Lond). 2015; 2: 17.
- Wong WL, Su X, Li X, et al. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis. Lancet Glob Health. 2014; 2(2): e106–e116.
- Flaxman S, Bourne R, Resnikoff S, et al. Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis. The Lancet Global Health. 2017; 5(12): e1221–e1234.
- Wecker T, Ehlken C, Bühler A, et al. Five-year visual acuity outcomes and injection patterns in patients with pro-re-nata treatments for AMD, DME, RVO and myopic CNV. Br J Ophthalmol. 2017; 101(3): 353–359.
- Ou WC, Brown DM, Payne JF, et al. Relationship Between Visual Acuity and Retinal Thickness During Anti-Vascular Endothelial Growth Factor Therapy for Retinal Diseases. Am J Ophthalmol. 2017; 180: 8–17.
- Johnson MK, Lara N. PSS18 Direct Economic Burden of Regular Intravitreal Injections for the Treatment of Retina Diseases in Three European Countries. Value Heal. Elsevier Inc. 2011; 14(7): A505. https://linkinghub.elsevier.com/retrieve/pii/S1098301511030452.
- Hollingworth W, Jones T, Reeves BC, et al. A longitudinal study to assess the frequency and cost of antivascular endothelial therapy, and inequalities in access, in England between 2005 and 2015. BMJ Open. 2017; 7(10): e018289.
- Dakin HA, Wordsworth S, Rogers CA, et al. IVAN Study Investigators. Cost-effectiveness of ranibizumab and bevacizumab for age-related macular degeneration: 2-year findings from the IVAN randomised trial. BMJ Open. 2014; 4(7): e005094.
- Hutton D, Newman-Casey PA, Tavag M, et al. Switching to less expensive blindness drug could save medicare part B $18 billion over a ten-year period. Health Aff (Millwood). 2014; 33(6): 931–939.
- Narayanan R, Panchal B, Das T, et al. MARVEL study group. A randomised, double-masked, controlled study of the efficacy and safety of intravitreal bevacizumab versus ranibizumab in the treatment of macular oedema due to branch retinal vein occlusion: MARVEL Report No. 1. Br J Ophthalmol. 2015; 99(7): 954–959.
- Martin DF, Maguire MG, Fine SL, et al. Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group. Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results. Ophthalmology. 2012; 119(7): 1388–1398.
- Raftery J, Clegg A, Jones J, et al. Ranibizumab (Lucentis) versus bevacizumab (Avastin): modelling cost effectiveness. Br J Ophthalmol. 2007; 91(9): 1244–1246.
- van Asten F, Michels CTJ, Hoyng CB, et al. The cost-effectiveness of bevacizumab, ranibizumab and aflibercept for the treatment of age-related macular degeneration-A cost-effectiveness analysis from a societal perspective. PLoS One. 2018; 13(5): e0197670.