The impact of different anti-vascular endothelial growth factor treatment regimens on reducing burden for caregivers and patients with wet age-related macular degeneration in a single-center real-world Japanese setting

Abstract

ObjectiveTo describe the burden associated with different anti-vascular endothelial growth factor (VEGF) treatment strategies for wet age-related macular degeneration (wAMD) in a real-word setting in Japan.MethodsSingle-center, cross-sectional survey of caregivers of patients with wAMD performed in a hospital in Mito-City, a rural area in Japan. Caregiver burden was evaluated using the Burden Index of Caregivers (BIC-11), and depressive symptoms were assessed by the Center for Epidemiologic Studies Depression scale. Retrospective medical chart review was conducted to monitor resource use and visual acuity outcomes in patients. The productivity loss of caregivers accompanying patients on hospital visits was estimated using the human capital method.ResultsSeventy-one patient-caregiver pairs were included. Most caregivers were female (74.6%), spouse/partner (54.9%), employed (46.5%), and the primary caregiver (85.9%). Patients received anti-VEGF treatment as follows: treat-and-extend (T&E; n = 42), switch (from as-needed [PRN] to T&E; n = 18), PRN (n = 10), and other (n = 1). Caregiver-related burden (total BIC-11 scores) were 4.29 (T&E) 4.60 (PRN), and 5.33 (switch) (p = NS).The mean number of hospital visits was lower with T&E than PRN (7.88 vs. 14.0 [p = 0.00674] in year 1 and 5.68 vs. 9.0 in year 2). For patients who switched from PRN to T&E, the mean number of hospital visits decreased from 13.21 to 7.43 (p<0.0001) in the first year after switch. The productivity loss associated with accompanying patients to the hospital was lower for caregivers of patients receiving T&E than PRN (mean differences: 74,456.04 JPY [p = 0.00284] in year 1 and 40843.14 JPY in year 2), and was also reduced for caregivers of patients who switched from PRN to T&E.ConclusionwAMD treatment with anti-VEGF agents via T&E reduced hospital visits compared with PRN, where associated monitoring visits are necessary to provide good patient outcomes. T&E was associated with a reduction trend in caregiver burden, including time and costs.

Anti-vascular endothelial growth factor in neovascular age-related macular degeneration – a systematic review of the impact of anti-VEGF on patient outcomes and healthcare systems

“…Two studies reported on the cost savings associated with the use of anti-VEGF treatments in nAMD patients [ 42 , 43 ]. Windsor et al concluded that the use of optical coherence tomography (OCT)-guided anti-VEGF therapy (i.e.…”

“…The total patient savings by using OCT-guided anti-VEGF therapy (based on a 20% copay for anti-VEGF therapy, and avoiding 17.7 million IVIs from 2008 to 2015) could amount to $2.2 billion. Hanemoto et al showed cost savings associated with the implementation of a proactive treat-and-extend (T&E) regimen when compared with as-needed dosing, mostly due to a reduction in hospital visits [ 42 ]. The T&E regimen was also associated with reduced caregiver burden.…”

Long-Term Visual Outcomes for a Treat-and-Extend Antivascular Endothelial Growth Factor Regimen in Eyes with Neovascular Age-Related Macular Degeneration: Up to Seven-Year Follow-Up

“…However, these pivotal trials were based on monthly injections, which in real-life long-term settings are of significant burden for patients, caregivers, healthcare practitioners, and healthcare systems [11]. Alternative treatment regimens therefore emerged.…”

Effectiveness of interventions to increase uptake and completion of treatment for diabetic retinopathy in low- and middle-income countries: a rapid review protocol.

“…22 The dependence on a caregiver to accompany the patient and the financial cost of treatment also pose a burden on the patient. 23,24 This rapid review aims to identify and summarize the most recent information on the effectiveness of interventions to increase uptake and completion of treatment for DR and/or DMO in LMICs.…”