BackgroundThe intravitreal anti-vascular endothelial growth factor treatments ranibizumab and aflibercept have proven efficacy in clinical trials, but their real world usage in central retinal vein occlusion (CRVO) has not been assessed. We therefore evaluated the treatment patterns of both drugs in a US claims database.MethodsThe IMS Integrated Data Warehouse was used to identify the patients with CRVO in the USA with claims for ranibizumab or aflibercept between 24 September 2012 and 31 March 2014 with at least 12 months follow-up. Patients were required to have had no anti-VEGF treatment code for 6 months before index (‘treatment-naive'). Mean numbers of injections and non-injection visits to a treating physician were compared with patients receiving these treatments.ResultsPatient characteristics were similar for patients receiving ranibizumab (n=206) or aflibercept (n=79) at index. The mean (±SD) numbers of injections received by patients treated with ranibizumab or aflibercept were 4.4±2.8 and 4.7±2.9 (P=0.38), respectively; the total number of patient visits to their treating physician was 7.3±3.7 and 7.0±2.9 (P=0.52), respectively. For patients receiving one or more injections (n=238), the mean interval between injections was 55.1 days (ranibizumab) and 54.2 days (aflibercept; P=0.44).ConclusionsOur results suggest that, in routine clinical practice, patients receive a comparable number of injections in the first year of treatment with ranibizumab or aflibercept. This may have implications for commissioning and service development of CRVO care pathways.

PurposeRanibizumab, an anti-vascular endothelial growth factor, and dexamethasone, a corticosteroid, have been shown to be effective in treating macular oedema secondary to retinal vein occlusion (RVO) (central RVO (CRVO) and branch RVO (BRVO)). Their real-world usage, however, has yet to be compared. We therefore evaluated ophthalmology visits for both drugs using US patient-level data.MethodsThe IMS Health Real-World Data Medical Claims database was used to identify treatment-naive patients receiving ranibizumab intravitreal injections or dexamethasone intravitreal implants between June 2010 and February 2014 who had 12 months of follow-up data. The primary outcome measure was the mean number of all ophthalmology visits for the two drugs in patients with CRVO and BRVO. Secondary outcome measures included a comparison of treatment visits, non-treatment visits, and time intervals between visits.ResultsOverall, 2822 patients received ranibizumab injections (CRVO, 1178; BRVO, 1644) and 365 received dexamethasone implants (CRVO, 191; BRVO, 174). The mean number (SD) of all ophthalmology visits was higher for patients receiving ranibizumab injections than for those receiving dexamethasone implants (CRVO: 7.2 (3.6) vs 6.2 (3.1), P<0.001; BRVO: 7.1 (3.4) vs 6.3 (3.1), P=0.016).ConclusionsPatients with RVO receiving ranibizumab injections had a mean of approximately one more visit to their ophthalmologist in the first 12 months of treatment than those treated with dexamethasone implants. The visit burden is therefore not substantially different and physicians should focus on the clinical benefits of these drugs when evaluating treatment options for RVO.

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Objectives: Diabetic retinopathy/ DME are substantial complications leading to blindness. Ranibizumab (RBZ) 0.5mg and aflibercept (ABC) (anti-VEGF) change the DME-treatment paradigm. We estimated the cost-effectiveness of RBZ vs. ABC and laser from the Czech health care system perspective. MethOds: A Markov cohort model with 8 health states (based on visual acuity) + dead in life-time horizon (3% discount rate) was used. Base-line patient characteristics came from the RESTORE study; 60% of patients were treated for their worse seeing-eye. Patients who were treated in both eyes were not included in the analysis. Transition probabilities (efficacy) for the first 3 years of treatment for RBZ 0.5mg and laser were derived from RESTORE, for ABC from a published network meta-analysis (gain at least 10 letters: RBZ vs. ABC: OR = 1.59; 95%CrI 0.61 -5.37). Natural progression of disease came from Wisconsin Epidemiologic Study. Utility for better and worse seeing-eye were derived from literature. RBZ and ABC dosing came from RESTORE (pro re nata, PRN) and from VIVID-DME, VISTA-DME study (bi-monthly after 5 initial monthly doses), respectively. Cost parity per dose of anti-VEGF (€ 855) was assumed. Results: Using a life-time horizon, total (discounted) costs and QALYs for RBZ, ABC, laser were :€ 7,110; € 9,562; € 1.490 and 7.589; 7.502; 7.022 QALYs, respectively. The incremental costs and QALYs for RBZ vs. laser were € 5.620 and 0.567 QALYs, with base-case ICER of 9.918 € /QALY. RBZ vs. ABC brought 0.087 QALY gain with € 2.452 savings, reflecting dominance of RBZ over ABC. According to probabilistic sensitivity analysis, there is 64%/ 90% probability that RBZ's ICER is below 1GDP/ 3GDP per capita (€ 13,800/ € 40,000) compared to laser. There is 62% probability that RBZ compared to ABC brings more QALY with lower costs. cOnclusiOns: RBZ is dominant, cost-effective compared to ABC, laser approach, respectively in DME patients from the Czech health care system perspective.