Neovascular Age-Related Macular Degeneration: Prevalence and Treatment with Anti-Vegf from the Perspective of the Italian National Health System
Ronconi G1, Dondi L1, Calabria S2, Piccinni C2, Dondi L2, Dell'anno I2, Pedrini A2, Addesi A3, Esposito I4, Staurenghi G5, Martini N2
1Fondazione ReS (Ricerca e Salute) - Research and Health Foundation, Roma, RM, Italy, 2Fondazione ReS (Ricerca e Salute) - Research and Health Foundation, Casalecchio di Reno (Bologna), Italy, 3Drugs & Health srl, Rome, Italy, 4Drugs & Health srl, Rome, RM, Italy, 5ASST Fatebenefratelli Sacco, Milano, Italy
OBJECTIVES: To identify patients with neovascular age-related macular degeneration (nAMD) new users of vascular endothelial growth factor inhibitors (anti-VEGF), characterize them and assess their comorbidities, prescribing patterns, outpatient specialist care and healthcare integrated costs from the Italian National Health System’s (INHS) perspective.
METHODS: From the Fondazione ReS (Ricerca e Salute) database, among patients aged ≥55 with in-hospital diagnosis of nAMD and/or intravitreal therapy (supply of anti-VEGF/outpatient intravitreal administration – for non-specific drugs, other diseases were excluded) in 2018, new anti-VEGF users were selected and characterized by age, sex and comorbidities. Two-year anti-VEGF prescribing pattern, outpatient specialist care (optical coherence tomography – OCT, fluorescein angiography, fundus photography and eye examination) and costs charged to the INHS were assessed.
RESULTS: From ~5 million inhabitants in ReS database in 2018, among 8,125 patients with nAMD (4.6 x1,000 inhabitants aged ≥55), 1,513 were new users of anti-VEGF (18.3% of nAMD-patients; mean age 74±9; 50% females), with incidence (0.9 x1,000) increasing with age. About 60% of new users had ≥2 comorbidities (mainly hypertension and dyslipidaemia). On average, in the first year, 4.8 anti-VEGF administrations occurred (vs 3.6 for only 40.9% subjects, in the second year). Aflibercept was the first choice in 52.5% of new users, whereas, ranibizumab in 47.3%. Within 1st follow-up year, 92.4% (vs 88.3% during 2nd follow-up year) patients benefited from ≥1 outpatient specialist care: 4.9% (vs 4.1%), 9.1% (vs 5.3%), 1.5% (vs 1.2%) and 32.7% (vs 21.3%) new users underwent OCT, fluorescein angiography, fundus photography and eye examination, respectively. On average, within 1st year, the INHS spent €6,726 (44.6% for anti-VEGF drugs) per patient, while €3,282 (46.6% due to hospitalizations for all causes) within the second one.
CONCLUSIONS: Due to limitations of administrative healthcare data, prevalence of nAMD was largely underestimated. However, the strong reductions in treatment administrations and outpatient follow-ups are worthy of attention.
Conference/Value in Health Info
Value in Health, Volume 25, Issue 12S (December 2022)
Epidemiology & Public Health, Health Policy & Regulatory, Study Approaches
Public Health, Public Spending & National Health Expenditures
No Additional Disease & Conditions/Specialized Treatment Areas