Patient Preferences for Anti-VEGF Treatment Regimens for Wet Age-Related Macular Degeneration in Japan

Abstract

Purpose : To quantify preferences for different anti-vascular endothelial growth factor (anti-VEGF) treatment profiles among patients with wet age-related macular degeneration (wAMD).

Methods : Patients with a best corrected visual acuity (BCVA) in their better-seeing eye of at least a decimal notation of 0.5 (approximately 20/40 at Snellen equivalent) participated in a face-to-face cross-sectional survey across 4 university hospitals in Japan between November 2017 and June 2018. The survey included explanations of pro re nata (PRN), every two months (q8), and treat-and-extend (TAE) treatment strategies using a standardized script and a discrete choice experiment (DCE) in which patients were asked to review two different treatment profiles side-by-side and choose their preferred option. The different profiles were defined based on 4 attributes: 1-year number of injections, 1-year physician consults, chance of 1-year visual acuity (VA) improving, and chance of 2-year VA maintenance of improvement. A Hierarchical Bayes model was applied to estimate preference weights for each level of the regimen attributes.

Results : A total of 120 patients with wAMD with a mean age of 76 ± 8.0 years (female: 41%) completed the survey. Thirty patients were anti-VEGF naïve and ninety patients were anti-VEGF experienced. Of the anti-VEGF experienced patients, approximately 71% were treated with PRN. Patients were willing to accept an increase from 3 to approximately 8 injections in the first year to increase the chance of 1-year VA improvement from 25% to 40%; however, they would be willing to accept 11 injections if the chance of 2-year VA maintenance increased from 80% to 96%. The most valued attribute was 2-year VA maintenance (34%), followed by reducing the number of injections (31%). These factors were about twice as important as decreasing physician consults and increasing the chance of VA improvement (P < 0.001). When comparing different regimen profiles (TAE, q8, and PRN) based on their attributes, TAE was generally more favored by patients primarily because of its high chance of 2-year VA maintenance.

Conclusions : Informing patients with wAMD about the likelihood of long-term VA maintenance when selecting treatment is likely to increase the chance of accepting an optimal treatment regimen and number of injections.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.