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Yi-Sheng Chang; Real-world use of ranibizumab for neovascular age-related macular degeneration as determined by national health insurance coverage in Taiwan. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3204.
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To investigate the "real-world" use of ranibizumab for neovascular age-related macular degeneration (nAMD) under the Taiwan National Health Insurance (TNHI) system and assessed the visual outcome.
We reviewed the medical records at National Cheng Kung University Hospital, Taiwan, during 2012–2014 for 264 consecutive eyes of 229 patients with nAMD, who applied for ranibizumab covered by TNHI.
A total of 194 eyes (73.5%) in 179 patients (65.5% men; mean ± standard deviation age 69.4 ± 10.7 years) were pre-approved for treatment. Applications for treatment increased year by year, but approvals decreased during this time. The major causes of rejection by the TNHI were diseases mimicking nAMD including macular pucker/epiretinal membrane, macular scarring, dry-type AMD, and possible polypoidal choroidal vasculopathy. In pre-approved eyes, only 147 (75.8%) eyes were treated with three injections of ranibizumab at acceptable intervals. After completion of three injections, visual acuity significantly improved, gaining ≥1 line in 51.8% of eyes and stabilizing in 38.3% of 141 eyes in which visual acuity was measured. Of note, the 114 eyes approved with only one application had a better visual outcome than the 27 eyes approved after the second or third applications.
Ranibizumab is effective for nAMD; however, approval after the second or third application for TNHI cover is a less favorable predictor of visual outcome. We concluded that the number of application(s) to the TNHI for funding acts as a predictor of visual outcome.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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