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 1^st follow-up year, 92.4% (vs 88.3% during 2^nd 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 1^st 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.