The burden of neovascular age-related macular degeneration: a patient&amp;rsquo;s perspective

Spooner, Kimberly; Mhlanga, Cleopatra T; Hong, Thomas; Broadhead, Geoffrey; Chang, Andrew

doi:10.2147/opth.s185052

Cited by 91 publications

(94 citation statements)

References 34 publications

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“…27 The NEI-VFQ-25 scores reported herein were also lower (ie, poorer) than previously reported in patients with neovascular AMD in two ranibizumab clinical trials (MARINA and ANCHOR) at baseline, as well as in a cross-sectional, non-interventional study in patients undergoing anti-vascular endothelial growth factor therapy. 25,28 In line with our NEI-VFQ-25 findings, patients with GA were found to have poorer VA at study entry than those without GA, with the majority of patients in the GA group having moderately low vision or blindness in one or both eyes. One in 5 of the patients with GA were either registered as blind or undergoing the registration process, which supports previous findings from a UK EMR study in which 7.1% were eligible for blindness registration in the United Kingdom at diagnosis, with a further 16% being eligible as vision impairment increased over time (median time to outcome, 6.2 years).…”

Section: Discussionsupporting

confidence: 73%

<p>Burden of Illness in Geographic Atrophy: A Study of Vision-Related Quality of Life and Health Care Resource Use</p>

Patel¹,

Ziemssen²,

Ng³

et al. 2020

OPTH

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Purpose: To gain comprehensive information on the burden of illness due to geographic atrophy (GA). Methods: This cross-sectional study with a retrospective chart review involved patients aged ≥70 years with physician-confirmed bilateral symptomatic GA due to age-related macular degeneration (GA group), as well as patients of similar age with no ophthalmic condition that in the opinion of the investigator affected visual function (non-GA group). Data relating to patients' current disease status and sociodemographics were self-reported on patient questionnaires at study entry and extracted from patient charts. Historical data on health care resource utilization (HCRU) were also collected via patient questionnaires and retrospective chart review (GA group only). Overall vision-related functioning and quality of life (QoL) were compared between the GA and non-GA groups using the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) composite and subscales, and change in vision over the past year was assessed using the Global Rating of Change Scale. Results: Vision-related functioning and QoL were poorer in patients with vs without GA (n=137 vs 52), as demonstrated by significantly lower NEI-VFQ-25 composite score (mean, 53.1 vs 84.5 points, respectively; P<0.001), as well as lower subscale scores for near activities, distance activities, dependency, driving, social functioning, mental health, role difficulties, color vision, and peripheral vision. Substantially more patients with GA than without GA reported worsening in vision over the past year (82% vs 25%, respectively; odds ratio, 13.55; P<0.001). In the GA group, associated mean annual costs for direct ophthalmological resource use per patient amounted to €1772 (mostly for tests/procedures), and for indirect ophthalmological resource use, €410 (mostly for general practitioner visits). Conclusion: Patients with GA experience a poorer level of vision-related function and QoL than their peers, especially in relation to driving. GA is also associated with notable HCRU/ associated costs, mostly direct costs attributed to diagnostic tests/procedures.

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Section: Discussionsupporting

confidence: 73%

<p>Burden of Illness in Geographic Atrophy: A Study of Vision-Related Quality of Life and Health Care Resource Use</p>

Patel¹,

Ziemssen²,

Ng³

et al. 2020

OPTH

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“…The literature review also identified studies that examined potential barriers to treatment, though these did not specifically address how these barriers correlated to adherence or persistence. 41 , 45 , 46 , 47 Additional risk factors reported in these studies include the differences in perceived treatment burden by patients or their caretakers of the various injection regimens, with lower burden index for patients on T&E regimen as compared to PRN, 45 and PRN more favourable as compared to monthly. 48 However, treating ophthalmologists reported difficulties of some patients in understanding the proactive nature of T&E regimens.…”

Section: Resultsmentioning

confidence: 99%

“… 47 Socioeconomic factors were also prominent in these studies with caretaker productivity loss (both time and financial) a significant burden. 45 , 46 Overall, treatment burden, both in terms of visit frequency and travel time was cited as the most significant barrier. 46 …”

Section: Resultsmentioning

confidence: 99%

Nonadherence or Nonpersistence to Intravitreal Injection Therapy for Neovascular Age-Related Macular Degeneration

et al. 2021

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Topic Systematic review of risk factors for non-adherence and non-persistence to intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection therapy for neovascular age-related macular degeneration (nAMD). Clinical Relevance Lack of adherence (non-adherence) or under-treatment (non-persistence) with respect to evidence from clinical trials remains a significant barrier to optimizing real-world outcomes for patients with nAMD. Contributing factors and strategies to address this are poorly understood. Methods Studies that reported factors for non-adherence and/or non-persistence to anti-VEGF therapy as well as studies examining strategies to improve this were included. Trial eligibility and data extraction were conducted according to Cochrane review methods. Risk of bias was assessed using the Mixed Method Assessment Tool and certainty of evidence evaluated according to the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative Research) tool. Data were collated descriptively. Results Of the 1284 abstract results screened, 124 articles were assessed in full and 37 studies met the inclusion criteria. Definitions of non-adherence and non-persistence varied or were not reported. Non-persistence occurred early with up to 50% of patients stopping treatment by 24 months. High rates of non-adherence were similarly reported, occurring in 32 – 95% of patients. Certainty of this finding was downgraded to moderate level due to heterogeneity in definitions used across studies. Multiple factors determine non-adherence and non-persistence, including at condition, therapy, patient, social/economic and health systems/health-care team level. Moderate quality evidence points to lower baseline vision and poorer response to treatment as condition-related variables. The effects of other factors were of lower certainty, predominantly due to small numbers and potential biases in retrospective assessment. Although many factors are non-modifiable (e.g., patient co-morbidity), other factors are potentially correctable (e.g., lack of transport or mismatched patient expectations). Evidence on strategies to improve adherence and persistence is limited, but where available, these have proven effective. Conclusions Awareness of factors related to poor patient adherence and persistence in nAMD could help identify at-risk populations and improve real world outcomes. Further work is required to develop uniform definitions as well as establishing high quality evidence on interventions that can be easily implemented.

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“…Due to the chronic nature of anti‐VEGF therapy, average annual out‐of‐pocket costs for nAMD or DMO patients typically exceed this level. Spooner et al reviewed the financial burden associated with intravitreal assessment and injections for 103 consecutive nAMD patients at a private clinic in Sydney and reported an average annual direct cost to patient of $2784 …”

Section: Introductionmentioning

confidence: 99%

Impact of out‐of‐pocket costs on patient initiation, adherence and persistence rates for patients treated with anti‐vascular endothelial growth factor medicines

Jackson¹,

Stokes

2020

Clinical Exper Ophthalmology

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Importance: Out-of-pocket costs are a key driver of patient decisions to access, adhere and persist with anti-vascular endothelial growth factor (VEGF) therapy. The Medicare Benefits Schedule Review Taskforce proposes a 69% reduction in the scheduled fee for intravitreal injections (item 42 738) which risks increasing out-of-pocket costs for patients and worsening visual outcomes.Background: To determine the impact of out-of-pocket costs on current anti-VEGF utilization rates in patients with neovascular age-related macular degeneration (nAMD) and diabetic macular oedema (DMO).

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The burden of neovascular age-related macular degeneration: a patient’s perspective

Cited by 91 publications

References 34 publications

<p>Burden of Illness in Geographic Atrophy: A Study of Vision-Related Quality of Life and Health Care Resource Use</p>

<p>Burden of Illness in Geographic Atrophy: A Study of Vision-Related Quality of Life and Health Care Resource Use</p>

Nonadherence or Nonpersistence to Intravitreal Injection Therapy for Neovascular Age-Related Macular Degeneration

Impact of out‐of‐pocket costs on patient initiation, adherence and persistence rates for patients treated with anti‐vascular endothelial growth factor medicines

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