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B.G. Foot, R. Foy, U. Chakravarthy, R.P. Wormald; The Third National Tracker Survey of Photodynamic Therapy in the UK National Health Service: Provision and Implications for National Guidance . Invest. Ophthalmol. Vis. Sci. 2003;44(13):178.
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Purpose: Photodynamic therapy (PDT) for the treatment of neovascular age-related macular degeneration is being introduced into the UK National Health Service (NHS) in an uncoordinated manner prior to a health technology appraisal by the National Institute for Clinical Effectiveness (NICE). Over three annual tracker surveys, we describe trends in the provision of PDT in the UK NHS and beliefs about what would constitute a worthwhile level of clinical benefit. Methods: We undertook surveys in each October of 2000, 2001 and 2002 of clinical directors/ lead consultants in all NHS eye units. These sought data on which (if any) patients were referred or treated with PDT and the thresholds of support for the use of PDT. This was measured in numbers needed to treat (NNT) to prevent the loss of three lines of visual acuity for 2 years for one patient. Results: Response rates were 82%, 79% and 82%. The proportion of units routinely providing PDT for patients with more than 50% classic sub-foveal CNV increased from 8.5% in 2000 to 23% in 2001 and 31% in 2002 (p<0.001). Units referring or treating no patients decreased from 35% to 10% between 2000 and 2002 (p<0.001), whilst other units reported provision of a limited service or referral to private healthcare providers. The proportion of respondents requiring further evidence before supporting the use of PDT decreased from 33% in 2000 to 19% in 2001 and 20% in 2002. There was a significant change in beliefs of what constituted a worthwhile clinical benefit between 2000 and 2001, but opinions had not changed between the surveys in 2001 and 2002 (p=0.97). Conclusions: There is evidence of a continuing growth in the use and availability of PDT. 90% of units now offer some pathway to treatment; however, important inequities in reported provision and accessibility remain. Beliefs about what constitutes a worthwhile treatment effect may have stabilised. There might be some lag between the forming of these beliefs and implementation of local policy and service development. Additional factors may be driving the increase in provision, such as increasing familiarity with a new technique and pressure from groups advocating the use of PDT. Consequently, by the time the NICE health technology appraisal is published the national policy guidance could be determined by established service development, rather than vice versa.
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