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RP Wormald, B Foot, R Foy, U Chakravarthy; The Introduction of Photodynamic Therapy into the UK National Health Service: Variations in Availability and Beliefs about Clinical Benefit . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4393.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Debate continues over the value of photodynamic therapy (PDT) in the treatment of neovascular age-related macular degeneration (ARMD) within the UK National Health Service (NHS). New therapies are often introduced before full evaluation, leading to inequities in provision. We surveyed how provision of PDT in the UK NHS changed over a one-year period and assessed beliefs about what would be a worthwhile level of clinical benefit. Methods: Two surveys (Oct 2001, Oct 2002) of all clinical directors in UK NHS eye units. These sought data on which patients were referred or treated with PDT and the threshold at which the use of PDT would be supported. Benefit was presented as numbers needed to treat (NNT) to prevent the loss of three lines of visual acuity for 2 years for one patient at a given fixed cost. Results: 124/152 (82%) questionnaires were returned in the first survey and 110/152 (72%) in the follow up survey. The availability of PDT had significantly increased (p<0.001). The proportion of units routinely providing PDT for patients with more than 50% classic CNV increased from 9% to 23%, whilst those providing a limited service or referral to the private sector rose from 44% to 60%. Units offering no provision decreased from 27% to 6%. The proportion requiring further evidence before supporting the use of PDT decreased from 33% to 17% (p=0.009). There was a significant association between the threshold of support and level of service provision for both surveys (P=0.01). Conclusion: Although substantial variations exist, the reported availability of PDT has increased over the 12-month period. The thresholds (NNT) at which the introduction of PDT would be considered justifiable varied widely. This may further exacerbate variations and the priority given to PDT. Whilst advocates of PDT may interpret our data as an indication of the NHS failing to provide an effective therapy equitably, imbalance in the provision of this new therapy is evident. Although a full health technology appraisal is scheduled from the National Institute for Clinical Effectiveness PDT continues to be introduced in an uncoordinated manner.
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