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ANA Patricia MARQUES, Antonio Filipe Macedo, Amandio A Rocha-Sousa, Julian Perelman, António M Baptista, Rui Santana; Emergence of intravitreal injections in a National Health System: 2002-2012. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6088.
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© ARVO (1962-2015); The Authors (2016-present)
Intravitreal injections of antivascular endothelial growth factor (anti-VEGF) are an innovative procedure with well-proven benefits to preserve vision in certain eye conditions. The aim of this study was to examine the diffusion of this treatment in the Portuguese National Health System.
We used a database of all in-patient and day cases stays from all Portuguese public hospitals during period 2002-2012. We selected cases based on four procedures, ICD-9-CM codes: 1414, 1475, 1479, 149. Given that these procedures are not specific for intravitreal injections it is likely that our results captured cases that are not anti-VEGF injections. Because we were only interested in the diffusion of new anti-VEGF treatments we included years 2002-2005 as baseline because during that period drugs anti-VEGF were not licenced. We calculated absolute values, yearly rates of episodes and rates of patients treated per 100,000 habitants.
Our final sample included 98,408 episodes, 52% performed in men. The total number of episodes increased from 1,815 in 2002 to 25,106 in 2012 (mean annual increase of 32%). These values corresponded to an increase in ratios per 100,000 from 17.4 to 238.77. The highest increase was observed between 2007 and 2009 with an increase of 337%. The number of treated patients was six times higher in 2012 with 11,937 treated compared with 1,561 in 2002 (mean annual increase of 24%). The highest increase was also observed between 2006 and 2009. In 2012, 86.2% of the procedures were performed as day cases, representing an increase of 78.3% as compared to 2002. The percentage of patients older than 60 years increased from 60% in 2002 to 80% in 2012. Five diagnoses (See Figure: wet AMD, diabetic macular oedema, oedema of the retina, retinal neovascularization and non-specific AMD) were associated with 73% of these procedures in 2012, in contrast with only 16% in 2002.
The number of procedures grew exponentially since anti-VGEF treatments were approved. The aging of the population and the expected growth in conditions such as diabetes and AMD are likely to increase the demand for these procedures in years to come. These factors are likely to impose tremendous challenges to health services. That will happen not only due to the price of the procedures but also for number of physicians and other staff needed in Ophthalmology departments.
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