OBJECTIVES: Current understanding related to management of wet age-related macular degeneration (wAMD) suggests anti-VEGF treatment associated burden (injection frequency) leads to sub-optimal clinical outcomes (visual acuity gains). The objective of this study was to assess the association between anti-VEGF treatment frequency among wAMD patients in real-world setting and healthcare system capacity and spending.

METHODS: A targeted literature review was conducted to identify real-world evidence studies accessing based management of wAMD and their impact on clinical outcomes and resource utilization (injection frequency at Year 1 and Year 2). Statistical correlations were determined between the country-wise injection frequency at Year 1 and W.H.O. data on country-wise per-capita healthcare spending (PPP) and ophthalmologist density (number of ophthalmologists per million people). There were no major differences in baseline clinical and demographic characteristics of patients among identified studies.

RESULTS: Our analysis identified a mean number of 5.04 anti -VEGF injections in year 1, ranging from 2.7 injections in Russia to 8.7 injections in Canada. Healthcare per-capita spending (PPP) ranged from around $300 in India to above $10,000 in the USA. The ophthalmologist density ranged from 13 in India to 117 in Italy. In some countries including lower injection frequency (Year 1) was correlated with lower per capita healthcare spending and fewer ophthalmologists per million. In other countries, the variables considered were unable to explain the observed deviations in the mean number of injections given in year 1 as a function of per-capita healthcare spending and ophthalmologist density.

CONCLUSIONS: Our study aims at bringing retinal disease and the mode administration of anti-VEGFs into a broader healthcare systems perspective. Yet, the indicator available to us could only partially explain the country-to-country variations in the mean number of anti-VEGF injections administered. This work warrants future research aimed at including a link to clinical outcomes and additional factors.