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  • Anti-VEGF treatments provide economic value to patients and society

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    Review of: Economic Value of Anti–Vascular Endothelial Growth Factor Treatment for Patients With Wet Age-Related Macular Degeneration in the United States

    Mulligan K, Seabury S, Dugel P, et al. JAMA Ophthalmology, January 2020

    In this study, investigators evaluated the economic value of anti–VEGF treatments for U.S. patients with wet AMD.

    Study design

    The authors simulated visual outcomes from 168,820 patients age 65 years and older with wet AMD—this was used to calculate economic variables. The main outcomes included patient benefits, costs and societal value at 3 years. Patients were divided into 2 frequent scenarios: the less frequent group received a mean of 8.2 injections annually while the more frequent group received 10.5 injections annually.

    Outcomes

    The scenario of less frequent injections generated $1.1 billion at year 1 and $5.1 billion in year 3. More frequent injections generated $1.6 billion in year 1 and $8.2 billion in year 3. The authors found that more frequent injections were associated with $3 billion in patient benefits over a 3-year period, and adherence to treatment led to greater patient and societal value.

    Limitations

    The authors assume that 100% of patients started anti-VEGF treatment and the discontinuation rate was 6% per year. Patient adherence in real world scenarios may often be less than 6%, and patients may have difficulty coming in more frequently regardless of overall benefit. Additionally, patients may receive less frequent injection in real world scenarios than they did in the less frequent group, as many U.S. physicians treat wet AMD with a treat-and-extend protocol.

    Clinical significance

    In an accompanying editorial to this article, Melissa Brown, MD, and Gary Brown, MD, go into greater detail about the contributions of more frequent and less frequent treatments to society. Both the authors and the editorial note that more frequent injections incurred higher ophthalmic medical costs; however, these costs were offset by greater patient financial return on investment because of improved visual acuity outcomes. This study adds to the large body of evidence that suggests that the care that ophthalmologists provide has value not only to patients, but to society as a whole.