September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Cost-Benefit Analysis of Intravitreal Anti-VEGF Medications for the Treatment of Neovascular Age-Related Macular Degeneration in a Treat-And-Extend Regimen
Author Affiliations & Notes
  • Andrew Carey
    Ophthalmology & Visual Sciences, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
  • Stephen R Russell
    Ophthalmology & Visual Sciences, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
  • Footnotes
    Commercial Relationships   Andrew Carey, None; Stephen Russell, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 4983. doi:
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    • Get Citation

      Andrew Carey, Stephen R Russell; Cost-Benefit Analysis of Intravitreal Anti-VEGF Medications for the Treatment of Neovascular Age-Related Macular Degeneration in a Treat-And-Extend Regimen. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4983.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : A variety of medications and administration frequencies have been found to be effective for restoration and preservation of vision in patients with neovascular Age-Related Macular Degeneration (nAMD). Anecdotal reports have suggested differences in duration of action between intravitreal bevacizumab (IVB), intravitreal ranibizumab (IVR) and intravitreal aflibercept (IVA). Further, treat-and-extend (TAE) regimens have been proposed to reduce the treatment burden posed by monthly patient visits. The purpose of this study is to examine the cost-benefit of IVB compared to IVR and IVA in a TAE regimen.

Methods : We modeled monthly (q4w) and TAE to a 12-week interval regimens in the hospital-based and ambulatory clinic settings to examine the costs of exam and injection using IVB, IVR, and IVA for a self-payer, Medicare, and the Medicare (co-pay) patient. This theoretical model was then used to look at the cost-benefit ratio of IVR or IVA to IVB using the visual outcomes and injection frequency from a retrospective chart review of nAMD patients treated with a TAE regimen

Results : The results of the theoretical model comparing IVR or IVA to IVB in the same regimen (either q4w or TAE) demonstrated that parameters related to highest cost are as follows: in the hospital-based setting, the cost ratio to the self-payer, Medicare, and the Medicare patient was approximately 5.0 annually; in the ambulatory clinic setting, the cost ratio to the self-payer was approximately 6.7 and to Medicare and the Medicare patient approximately 11.8 annually.
The theoretical model showing the maximal difference between IVR or IVA (TAE) compared to IVB (q4w) are as follows: in the hospital-based setting, the cost ratio to the self-payer, Medicare, and the Medicare patient was approximately 2.7 in the first year and approximately 1.5 in subsequent years; in the ambulatory clinic setting, the cost ratio to the self-payer was approximately 3.6 in the first year and approximately 2.0 in subsequent years and to Medicare and the Medicare patient approximately 6.3 in the first year and 3.6 in subsequent years.

Conclusions : The use of IVB over IVR and IVA for the treatment of nAMD in either a q4w or a TAE regimen can result in significant cost savings to the self-payer, Medicare, and the Medicare patient.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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