Abstract
Purpose :
To compare the real-world treatment patterns, specifically, frequency and cost of intravitreal injections of two anti-vascular endothelial growth factor (anti-VEGF) agents, ranibizumab (RBZ) and aflibercept (AFL), for treatment of wet age-related macular degeneration (AMD) in treatment-naïve (TN) and previously-treated (PT) patients over 2 years.
Methods :
This retrospective US claims study included TN or PT patients who initiated RBZ or AFL treatment (index date [ID]) for AMD between 11-18-2011 and 7-31-2015. Patients were aged ≥18 years on the ID and were required to have continuous eligibility for 12 months (12M) prior to ID and for 12-24 months (24M) following ID without switching to another anti-VEGF agent. Injection frequency and cost for RBZ vs. AFL were compared at 12M and 24M using multivariable Poisson quasi-likelihood regressions (treating RBZ as reference) and multivariable generalized linear models with a log link and gamma distribution, respectively. All models were adjusted for patient demographics and clinical characteristics.
Results :
Over 12M, TN AMD patients receiving RBZ (N=2260) and AFL (N=1256) had a comparable unadjusted mean number of injections (5.4 vs. 5.4, adjusted incidence rate ratio [IRR] = 0.99, 95% confidence interval [CI] = 0.95 to 1.03, P = 0.558) and marginally lower injection costs with AFL vs. RBZ ($10,417 vs. $11,032, adjusted cost ratio [CR] = 0.93, 95% CI = 0.89 to 0.98, P = 0.008). At 24M, injection frequency and cost were comparable between RBZ (N=1018) and AFL (N=482) in TN patients (7.6 vs. 8.1, IRR = 1.06, 95% CI = 0.98 to 1.14, P = 0.168; $15,393 vs. $15,410, CR = 0.99, 95% CI = 0.89 to 1.09, P = 0.832). Over 24M, PT AMD patients receiving RBZ (12M N=873; 24M N=344) or AFL (12M N=1990; 24M N=847) had comparable injection frequency (12M 5.7 vs. 5.8, IRR = 0.99, 95% CI = 0.96 to 1.04, P = 0.984; 24M 9.3 vs. 9.6, IRR = 1.00, 95% CI = 0.92 to 1.08, P = 0.926) and costs (12M $11,589 vs. $11,521, CR = 0.97, 95% CI = 0.92 to 1.03, P = 0.393; 24M $18,548 vs. $19,202, CR = 1.03, 95% CI = 0.92 to 1.14, P = 0.629).
Conclusions :
This 2-year claims-based analysis shows that the real world treatment patterns for treatment-naïve and previously-treated patients, given RBZ or AFL for AMD, are comparable in costs and injection frequency.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.