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G. Shienbaum, O. P. Gupta, C. Fecarotta, C. D. Regillo, R. S. Kaiser; Management of Neovascular Age-Related Macular Degeneration Using Bevacizumab With the Treat and Extend Regimen: Clinical Results and Economic Impact. Invest. Ophthalmol. Vis. Sci. 2010;51(13):905.
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To evaluate the visual outcomes, number of injections, and direct medical cost of a "treat and extend" regimen (TER) in managing neovascular age-related macular degeneration (nAMD) with intravitreal bevacizumab.
Retrospective, interventional case series from a single clinical practice. All patients were treated every 4 weeks with intravitreal bevacizumab until no intraretinal or subretinal fluid was observed on optical coherence tomography (OCT). The follow-up interval was then extended continuously by 2 weeks until signs of exudation recurred. Exclusion criteria included history of photodynamic therapy. Main outcomes measured included initial and final visual acuities, number of injections, and maximum treatment interval.
Seventy-four patients were identified. The mean follow-up was 1.3 years. The mean Snellen visual acuity at baseline was 20/230 and improved significantly to 20/118 at 6 months (p<0.001), 20/109 at 12 months (p<0.001), and 20/106 at 24 months follow-up (p<0.001). The mean number of injections over the first year was 7.27. The OCT central retinal thickness decreased from 316 microns to 239 microns (p<0.05). Utilizing a TER regimen as outlined in this study, the annual direct medical cost per patient is $6,160.13. The annual direct medical cost per patient treated with ranibizumab utilizing MARINA and PrONTO trial protocols is $28,314.16 and $15,880.07, respectively.
Eyes with nAMD experienced significant visual improvement when managed with intravitreal bevacizumab using the treat and extend regimen. The visual outcomes are similar to the ranibizumab pivotal trials, but with less patient visits and injections.
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