Diffusion of anti-VEGF injections in the Portuguese National Health System

Abstract

ObjectivesTo analyse the temporal and geographical diffusion of antivascular endothelial growth factor (anti-VEGF) interventions, and its determinants in a National Health System (NHS).SettingNHS Portuguese hospitals.ParticipantsAll inpatient and day cases related to eye diseases at all Portuguese public hospitals for the period 2002–2012 were selected on the basis of four International Classification of Diseases 9th revision, Clinical Modification (ICD-9-CM) codes for procedures: 1474, 1475, 1479 and 149.Primary and secondary outcome measuresWe measured anti-VEGF treatment rates by year and county. The determinants of the geographical diffusion were investigated using generalised linear modelling.ResultsWe analysed all hospital discharges from all NHS hospitals in Portugal (98 408 hospital discharges corresponding to 57 984 patients). National rates of hospitals episodes for the codes for procedures used were low before anti-VEGF approval in 2007 (less than 12% of hospital discharges). Between 2007 and 2012, the rates of hospital episodes related to the introduction of anti-VEGF injections increased by 27% per year. Patients from areas without ophthalmology departments received fewer treatments than those from areas with ophthalmology departments. The availability of an ophthalmology department in the county increased the rates of hospital episodes by 243%, and a 100-persons greater density per km2 raised the rates by 11%.ConclusionsOur study shows a large but unequal diffusion of anti-VEGF treatments despite the universal coverage and very low copayments. The technological innovation in ophthalmology may thus produce unexpected inequalities related to financial constraints unless the implementation of innovative techniques is planned and regulated.

A noninterventional study to monitor patients with diabetic macular oedema starting treatment with ranibizumab (POLARIS)

“…Restrictions in healthcare systems may, in part, account for some of the variation in outcomes observed between countries. Access to ophthalmology facilities may also be an issue in some countries (Marques et al 2015). This also highlights that any differences in the number of patients enrolled between different clinics and countries could introduce bias in the current study.…”

“…It was also difficult to determine associations between number of injections and VA outcomes in subgroups due to small patient numbers, and the study was not designed to assess these in detail. Access to ophthalmology facilities may also be an issue in some countries (Marques et al 2015). in response to outcomes), and achievement of short-term gains may result in reduction of future injections despite the possibility of further improvement; this was evidenced in POLARIS (Table 4), which indicates that outcomes seem to drive injections e947 as much as injections drive outcomes when using as-needed regimens in DME.…”

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“…Clinical trials have showed that anti-VEGF intravitreal injections prevented vision loss in the majority of patients and, in some cases, significantly improved vision 2 3 5. The positive impact of anti-VEGF injections in visual outcomes2 6–8 combined with the lack of previous efficient treatments, led to rapid diffusion of anti-VEGF treatments in many countries 4 6 9 10…”