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Szilard Kiss, Pravin U Dugel, Kathleen Wilson, Alice Huang, David Smith, Helen Varker, Stephen S Johnston, Adam Turpcu; Treatment Patterns and Associated Costs of Anti-VEGF Therapy for Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5596.
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Compare intravitreal (ITV) anti-VEGF injection totals and associated costs in patients who received aflibercept (AFB) or ranibizumab (RBZ) for neovascular age-related macular degeneration (AMD).
Patients in this retrospective cohort study of US claims data received 1st- or 2nd-line ITV anti-VEGF treatment with RBZ or AFB (index date) from November 18, 2011-July 31, 2013 and were aged ≥18y on the index date with a ≥12 month baseline period of continuous insurance prior to this index date. AMD was diagnosed during the baseline period or on the index date (ICD-9-CM 362.52), and patients had ≥6 or ≥12 mo of follow-up post index date with no switch of anti-VEGF therapy. Number of injections and their associated costs were assessed for 6- and 12-mo follow-ups. Multivariable regression comparisons for AFB vs RBZ were adjusted for baseline patient demographics, comorbidities, and general health status indices.
A total of 486 AFB patients and 1329 RBZ patients had ≥6-mo of follow-up data (134 and 571, respectively, in 12-mo analyses). Mean [SD] number of injections was similar at 12-mo for AFB and RBZ recipients for 1st-line therapy (5.4 [2.9] vs 5.7 [3.7], respectively) and 2nd-line therapy (6.4 [3.3] vs 6.3 [3.5], respectively; Figure). Mean [SD] anti-VEGF therapy-related costs were comparable in AFB and RBZ recipients at 6 mo ($7244 [$4208] vs $7858 [$4805], respectively) and 12 mo ($11,046 [$6853] vs $11,417.81 [$8731], respectively). Multivariable regression showed that neither the number or costs of injections differed significantly between AFB and RBZ patients over the first 6- and 12-mo post index date (reference=RBZ: Incidence Rate Ratio [IRR]=0.97, 95% confidence interval [CI]=0.92-1.02, P=0.224 [6 mo]; IRR=0.93, 95%CI=0.82-1.05, P=0.224 [12 mo]; Cost Ratio [CR]=0.96, 95%CI=0.90-1.02, P=0.212 [6 mo]; CR=0.91, 95%CI=0.80-1.05, P=0.182 [12 mo]). Mean days between injections for AFB and RBZ differed by 2.9 days (44.8 and 41.9 days, respectively) for 1st-line patients and by 5.9 days (47.7 and 41.7 days, respectively) for 2nd-line patients.
Injection frequency, days between injections, and costs did not differ significantly between AFB and RBZ over 6 and 12 mo in this claims analysis of AMD patients. Further follow-up is warranted; however, this initial analysis suggests AFB and RBZ treatment patterns and costs in AMD are similar in a real-world setting.
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