scholarly journals Cost-minimisation analysis of a treat-and-extend regimen with anti-VEGFs in patients with neovascular age-related macular degeneration

2021 ◽  
Author(s):  
S. W. Quist ◽  
L. A. de Jong ◽  
F. van Asten ◽  
P. Knoester ◽  
M. J. Postma ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Cost Minimisation Analysis ◽  
Patient Costs ◽  
Treat And Extend ◽  
Age Related ◽  
Injection Frequency ◽  
Cost Minimisation ◽  
Endothelial Growth Factors

Abstract Purpose Although intraocular anti-vascular endothelial growth factors (anti-VEGFs) are effective as treatment of neovascular age-related macular degeneration (nAMD), the (economic) burden on the healthcare system is considerable. A treat-and-extend (T&E) regimen is associated with a lower number of injections without compromising the effectiveness and can therefore help optimise nAMD treatment. This study investigates the per-patient costs associated with nAMD treatment, when using aflibercept, bevacizumab, or ranibizumab with a T&E regimen. Methods In this cost-minimisation model, the per-patient costs in the Netherlands were modelled using a healthcare payers’ perspective over a 3-year time horizon with the assumption that efficacy of treatments is similar. Additionally, the break-even price of the different anti-VEGFs was calculated relative to the cheapest option and injection frequency. Results The injection frequency varied from 14.2 for aflibercept to 27.4 for bevacizumab in 3 years. Nonetheless, bevacizumab remains the cheapest treatment option (€14,215), followed by aflibercept (€18,202) and ranibizumab (€31,048). The medication covers the majority of the per-patient costs for aflibercept and ranibizumab, while administration covers the majority of the per-patient costs for bevacizumab. The break-even prices of aflibercept and ranibizumab are respectively €507 and €60.58 per injection. Brolucizumab was included in the scenario analysis and was more expensive than aflibercept (€20,446). Brolucizumab should reduce to 13.8 injections over 3 years to be as costly as aflibercept. Conclusion Bevacizumab is the cheapest anti-VEGF treatment. The list prices of all anti-VEGFs should reduce to be as costly as bevacizumab. Aflibercept is the second-choice treatment and so far brolucizumab is not.

scholarly journals The role of future treatments in the management of neovascular age-related macular degeneration in Europe

2021 ◽  
pp. 112067212110183
Author(s):  
Laurent Kodjikian ◽  
Carl Joe Mehanna ◽  
Salomon-Yves Cohen ◽  
François Devin ◽  
Sam Razavi ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Macular Degeneration ◽  
Age Related Macular Degeneration ◽  
Phase Iii ◽  
Vascular Endothelial ◽  
Real World Data ◽  
Phase Iii Clinical Trials ◽  
Age Related ◽  
Injection Frequency ◽  
Endothelial Growth Factor

Anti-vascular endothelial growth factor (VEGF) agents have transformed the management of patients with neovascular age-related macular degeneration (nAMD) over the past two decades. However, as more long-term real-world data become available, it is clear that treatment outcomes are inferior to those reported in large, controlled clinical trials. This is largely driven by undertreatment, that is, not maintaining a consistent injection frequency to achieve sustained VEGF suppression, whether due to patient non-compliance, an important injection burden, or non/incomplete anatomical response. Newer therapeutic advances under evaluation hold promise in achieving more, for less. We review the latest drugs currently in or having successfully finished phase III clinical trials, and determine their potential place in the management of patients with nAMD in Europe.

scholarly journals Treat and Extend Treatment Interval Patterns with Anti-VEGF Therapy in nAMD Patients

Vision ◽  
2019 ◽  
Vol 3 (3) ◽  
pp. 41
Author(s):  
Skelly ◽  
Bezlyak ◽  
Liew ◽  
Kap ◽  
Sagkriotis
Keyword(s):  
Age Related Macular Degeneration ◽  
First Year ◽  
Vascular Endothelial ◽  
Randomised Study ◽  
Treat And Extend ◽  
Treatment Interval ◽  
Anti Vegf ◽  
Age Related ◽  
Treatment Naïve ◽  
Endothelial Growth Factors

Treat and extend (T&E) is a standard treatment regimen for treating neovascular age-related macular degeneration (nAMD) with anti-vascular endothelial growth factors (anti-VEGFs), but the treatment intervals attained are not well documented. This retrospective, non-comparative, non-randomised study of eyes with nAMD classified treatment interval sequences in a T&E cohort in Australia using Electronic Medical Records (EMR) data. We analysed data from 632 treatment-naïve eyes from 555 patients injected with ranibizumab, aflibercept or unlicensed bevacizumab between January 2012 and June 2016 (mean baseline age 78.0). Eyes were categorised into non-overlapping clusters of interval sequences based on the first 12 months of follow-up. We identified 523 different treatment interval sequences. The largest cluster of 197 (31.5%) eyes attained an 8-week treatment interval before dropping to a shorter frequency, followed by 168 (26.8%) eyes that did not reach or attained a single 8-week interval at the end of the study period. A total of 65 (10.4%) and 83 (13.3%) eyes reached and sustained (≥2 consecutive injection intervals of the same length) an 8 and 12 weekly interval, respectively. This study demonstrates highly individualised treatment patterns in the first year of anti-VEGF therapy in Australia using T&E regimens, with the majority of patients requiring more frequent injections than once every 8 weeks.

scholarly journals Stem Cell and Gene Therapy For Wet-Form (Neovascular) Age-Related Macular Degeneration

2017 ◽  
pp. 241-245
Keyword(s):  
Stem Cell ◽  
Macular Degeneration ◽  
Age Related Macular Degeneration ◽  
Treatment Modalities ◽  
Vascular Endothelial ◽  
Gene Therapies ◽  
Age Related ◽  
Or Gene ◽  
Cell And Gene Therapy ◽  
Endothelial Growth Factors

Treatment of wet-form (neovascular) Age-Related Macular Degeneration is nowadays based on recurrent intravitreal injections of anti-vascular endothelial growth factors. But this treatment does not cure the patients or does not cause complete resolution of the disease. So there is a need for other treatment modalities such as stem cell or gene therapies. Nowadays there are ongoing or finished trials that give hope for the treatment of this disease.

Definition of Different Treatment Response Types In Neovascular Age-Related Macular Degeneration

2020 ◽  
pp. 1-6
Author(s):  
Ayse Gul Kocak Altıntas ◽  
Keyword(s):  
Macular Degeneration ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Neovascular Amd ◽  
Choroidal Neovascular Membrane ◽  
Age Related ◽  
The Status ◽  
Definition Of ◽  
Endothelial Growth Factors ◽  
Subretinal Drusenoid Deposits

Age-related macular degeneration (AMD) is a common, degenerative disease of the retina presented as neovascular AMD (n-AMD) or non‐neovascular AMD. Several factors risk factors having been found associated with unresponsive to treatment and progression macular scar form, including subtype of the choroidal neovascular membrane (CNM), presence of subretinal drusenoid deposits, Pigment epithelial detachment (PED), decreased central choroidal thickness, preexisting Macular atopy (MA) in the fellow eye. There is no exact consensus about the term described the status of poor or non- response to any treatment regime. In this article definition of different therapeutic responses such as resistance, refractory, recurrence of anti-vascular endothelial growth factors (AntiVEGF), and its relation to retinal features are discussed.

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