Care Pathway of Patients With Neovascular Age-Related Macular Degeneration Treated by Anti-VEGF in France, Using Clustering Analysis Combined With Optimal Matching

Speaker(s)

Matonti F1, Berdeaux G2, Civet A3, Pau D3, Pibre S3, Despres J4, Borsik B4, Korobelnik JF5
1Centre Monticelli Paradis d’Ophtalmologie ; Clinique Juge, Almaviva Santé, Marseille, France, 2BERDEAUX consulting SAS, Lacanau, France, 3Roche SAS, Boulogne-Billancourt, France, 4IQVIA France, Courbevoie, France, 5CHU Bordeaux, Service d'ophtalmologie ; Univ. Bordeaux, INSERM, BPH, UMR1219, Bordeaux, France

OBJECTIVES: Neovascular Age-related macular degeneration (nAMD) is a leading cause of visual impairment and blindness. A real-world retrospective study (HEMERA), using data from the French National Health Data System (SNDS) claims databases, aimed to describe the anti-VEGF usage, including the care pathways, in nAMD patients in France.

METHODS: The analysis aimed to group patients with a similar care pathway to identify “patient journeys”. The follow-up (first, second and third year) for each patient, assessed from first anti-VEGF intravitreal injection (IVT) between 2016 and 2019, was converted into sequences of weekly states (i.e. event(s) of interest most observed among: IVT and exams, IVT, multiple exams, Optical Coherence Tomography (OCT), Angiography, Ophthalmologist visit, Orthoptist visit). A dissimilarity matrix summarized results of the two-by-two comparison of all sequences using the optimal matching technique. Hierarchical clustering was applied to group the sequences.

RESULTS: Only the first year of follow-up is described. We identified 5 clusters of sequences that grouped respectively 61,015 (60.5%), 28,270 (28.1%), 6,721 (6.7%), 3,135 (3.1%) and 1,634 (1.6%) patients. Cluster 1 gathered patients with 1 IVT Q4W during the first 3 months (at Month 0 (M0), M1 and M2) followed by OCT around 1 month and 3 months after the last IVT. Cluster 2 gathered patients with 1 IVT Q4W during the first 3 months followed by OCT Q6W and IVT Q10W. Cluster 3 gathered patients with 1 IVT at M0 and M1, followed by 1 IVT and OCT/Angiography Q8W from M2. Cluster 4 gathered patients with 1 IVT Q4W during the first 3 months followed by a visit to an orthoptist + OCT Q4W during the 3 next months and Q8W during the last 6 months.

CONCLUSIONS: We confirmed disparities in real life treatment management of patients with nAMD treated with anti-VEGF from the first year of treatment, especially after the first 3 months.

Code

HSD58

Disease

No Additional Disease & Conditions/Specialized Treatment Areas, Sensory System Disorders (Ear, Eye, Dental, Skin)