anti-VEGFs Use in Neovascular Age-Related Macular Degeneration: An Analysis of the National Report on Medicines Use in Italy

OBJECTIVES: Neovascular age-related macular degeneration (nAMD) is the leading cause of vision loss in the elderly, negatively affecting patients’ quality of life. Anti–vascular endothelial growth factor therapies (anti-VEGFs) are the current standard of care for nAMD. However, real-world studies revealed suboptimal outcomes due to the frequent need for therapeutic interventions, burdening patients and healthcare systems. The objective of this study was to analyze the consumption of anti-VEGFs in Italy and present potential strategies to enhance treatment appropriateness.

METHODS: National consumption data were used. Approved anti-VEGFs differ in their ability to provide extended treatment intervals: <7 (IVT<7), 7 (IVT7), and >7 (IVT>7) injections/year, according to Nota 98 prescription appropriateness report. Appropriateness was defined as the ratio of the observed annual mean injections number with Nota 98 report and Summary of Product Characteristics value. National treatment acquisition and administration costs were considered. Two scenarios were investigated: (1) maximizing appropriateness while maintaining fixed expenditure, (2) minimizing expenditure to achieve 80% appropriateness level.

RESULTS: 27,401 eyes started an approved anti-VEGF therapy in Italy in 2021: 33.5% received IVT>7, 57.0% received IVT7, and 9.5% received IVT<7. The estimated appropriateness was 46.6%, with a total expenditure of €93.9 million for 100,851 injections. Greater use of IVT<7 products can increase appropriateness to 57.7%, resulting in a reduction of both injections (-2.1%) and expenditure (-6.7%). Achieving 80% appropriateness required higher injection capacity (+35.8%) and increased expenditure (+29.6%). Additionally, considering anti-VEGF with <6 injections/year (IVT<6), achieving 80% appropriateness required less investments (+22.9%) and only a modest increase of injections (+26.6%).

CONCLUSIONS: Greater use of IVT<7 products can enhance appropriateness (+11.1%) in the fixed expenditure scenario. Achieving 80% appropriateness depends on the capacity of treatment centers and the financial feasibility for payers. The availability of IVT<6 products resulted in achieving 80% appropriateness with the lowest economic effort and a limited increase in injections.