OBJECTIVES: nAMD is a chronic condition, requiring life-long treatment, with substantial impacts on quality of life and independence. It affects 14 million people worldwide today, 19 million by 2030.

Anti-VEGF therapies represent current standard of care for nAMD. While efficacy is established in controlled clinical trials (7-12 injection/year), sub-optimal outcomes and irreversible vision loss are observed in clinical practice due to low adherence to burdensome treatment regimens: Italian RWE analysis on nAMD anti-VEGF treated patients highlights just 3.6 and 1.1 injections received, in first and second years.

Our aim was to quantify people with vision loss that benefit of National Social Security Income (NSSI) and the related social expenditure trend in Italy, in order to understand to which extent treatment inappropriateness is followed by appropriate social assistance.

METHODS: Yearly social security expenditure analysis for the 2017-2020 time period was conducted on the open-access National Social Security Cost (NSSC) database. Attendance allowance (AA) and Social Security Income (SSI) tariffs trends were analyzed for both totally blind (TB) and partially blind (PB) patients.

RESULTS:

SSI beneficiaries continue to growth (from 118.842 in 2017 to 123.044 in 2020), a trend that affects both PB and TB beneficiaries.

On the other side, the total annual social expenditure for TB and PB beneficiaries remains approximately stable, at 1 billion euro since 2017. Since TB and PB beneficiaries are steadily increasing, this trend inevitably corresponds to a decrease of single AA and SSI tariffs.

CONCLUSIONS: Official NSCC database analysis highlights that the inappropriateness factors in anti-VEGF treatments are not backed up by appropriate social expenditure. The approach of stakeholders in our system towards a comprehensive management of nAMD appears to be fragmented and not strategically linked. Payers, Institutions and Patients should reflect on this evidence and promptly act, ensuring visual acuity using a value-based approach integrating healthcare and social welfare.