NO COUNTRY FOR OLD MEN: AGE-GEOGRAPHIC CONVERGENCE OF UNMET NEED IN ANTI-VEGF THERAPY FOR NEOVASCULAR AMD IN CZECHIA ACCORDING TO A NATIONAL EPIDEMIOLOGICAL-ACCESSIBILITY ANALYSIS
Author(s)
Klára Klímova, M.Sc.1, Anna Lukacisinova, Ph.D.1, Jakub Novák, PhD1, Pavel Nemec, M.D.2, Miroslav Veith, M.D., Ph.D.3.
1Roche s.r.o., Prague, Czech Republic, 2Lexum – Ophthalmology Clinics, Prague, Czech Republic, 3Ophthalmology Clinic of the University Hospital Kralovske Vinohrady, Prague, Czech Republic.
1Roche s.r.o., Prague, Czech Republic, 2Lexum – Ophthalmology Clinics, Prague, Czech Republic, 3Ophthalmology Clinic of the University Hospital Kralovske Vinohrady, Prague, Czech Republic.
OBJECTIVES: Neovascular age-related macular degeneration (nAMD) is the leading cause of severe vision loss in the elderly, with anti-VEGF intravitreal therapy (IVT) as standard of care. Despite substantial growth in Czech anti-VEGF delivery, concerns persist about residual unmet need. This study aimed to quantify the gap between epidemiological need and actual treatment; assess geographic accessibility and single-center dependency.
METHODS: European prevalence estimates were applied to Czech demographics to model expected nAMD patients by age band and region. Treatment data from the National Registry provided actual patient counts. Geographic accessibility was modeled using 45-minute driving isochrony for 59 anti-VEGF centers, overlaid with municipal population data. Regional epidemiological coverage was cross-linked with geographic access and single-node dependency metrics.
RESULTS: Against an estimated nAMD population of ~43,000 (60+), only 20,357 patients received treatment in 2024 (~50% coverage). A pronounced "scissors effect" emerged: coverage reached 98-128% at ages 60-69 but declined sharply up to 42% (85-89), and 24% (90+), concentrating ~20,000 of 21,800 untreated patients in the 75+ cohort. Despite +208% growth in treated eyes since 2019, coverage in 80+ remained below 53% — system expansion was absorbed by treatment intensification and indication diversification rather than reaching the oldest patients. Geographically, 92.9% of the ~11 million population had access to at least one center within 45 minutes, but 7.1% did not, and 16.3% depended on a single node. Treatment delivery was heavily concentrated in large centers, while several regions showed mismatch between catchment-area need and actual local service capacity.
CONCLUSIONS: Our analysis revealed a structural age-inequity concentrated in the 75+ population, amplified by geographic vulnerability. These results also provide an evidence base for locally tailored interventions matched to the specific drivers of undertreatment in each region, with the expected need for significant (+37-76 %) increase in injection capacity.
METHODS: European prevalence estimates were applied to Czech demographics to model expected nAMD patients by age band and region. Treatment data from the National Registry provided actual patient counts. Geographic accessibility was modeled using 45-minute driving isochrony for 59 anti-VEGF centers, overlaid with municipal population data. Regional epidemiological coverage was cross-linked with geographic access and single-node dependency metrics.
RESULTS: Against an estimated nAMD population of ~43,000 (60+), only 20,357 patients received treatment in 2024 (~50% coverage). A pronounced "scissors effect" emerged: coverage reached 98-128% at ages 60-69 but declined sharply up to 42% (85-89), and 24% (90+), concentrating ~20,000 of 21,800 untreated patients in the 75+ cohort. Despite +208% growth in treated eyes since 2019, coverage in 80+ remained below 53% — system expansion was absorbed by treatment intensification and indication diversification rather than reaching the oldest patients. Geographically, 92.9% of the ~11 million population had access to at least one center within 45 minutes, but 7.1% did not, and 16.3% depended on a single node. Treatment delivery was heavily concentrated in large centers, while several regions showed mismatch between catchment-area need and actual local service capacity.
CONCLUSIONS: Our analysis revealed a structural age-inequity concentrated in the 75+ population, amplified by geographic vulnerability. These results also provide an evidence base for locally tailored interventions matched to the specific drivers of undertreatment in each region, with the expected need for significant (+37-76 %) increase in injection capacity.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH39
Topic
Epidemiology & Public Health, Organizational Practices, Real World Data & Information Systems
Topic Subcategory
Public Health
Disease
Sensory System Disorders (Ear, Eye, Dental, Skin)