scholarly journals Burden of diabetic macular oedema in patients receiving antivascular endothelial growth factor therapy in South Korea: a healthcare resource use and cost analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e042484
Author(s):  
Ha-Lim Jeon ◽  
Hyesung Lee ◽  
Dongwon Yoon ◽  
Yeonkyung Lee ◽  
Jae Hui Kim ◽  
...  
Keyword(s):  
Growth Factor ◽  
Resource Use ◽  
Macular Oedema ◽  
Healthcare Resource ◽  
Diabetic Macular Oedema ◽  
Medical Costs ◽  
Healthcare Resource Use ◽  
Anti Vegf ◽  
Antivascular Endothelial Growth Factor ◽  
Endothelial Growth Factor

ObjectiveTo examine healthcare resource utilisation (HRU) and direct medical costs for patients with diabetic macular oedema (DME) treated with antivascular endothelial growth factor (anti-VEGF) in Korea by comparing with those for (1) patients with diabetes mellitus (DM) without retinopathy and (2) patients with neovascular age-related macular degeneration (nAMD) treated with anti-VEGF.DesignRetrospective cohort study.SettingThe Korean National Health Insurance (NHI) database from 1 January 2014 to 31 December 2016.ParticipantsWe identified 1398 patients older than 30 years of age who received anti-VEGF treatment for DME in 2015 after excluding patients who had a diagnosis of nAMD in 2015 and any cancer in the preceding year.Main outcome measuresOne-year healthcare resource use and direct medical costs of patients with DME treated with anti-VEGF.ResultsIn total, 1398 patients with DME receiving anti-VEGF, 12 813 patients with DM without retinopathy and 12 222 patients with nAMD receiving anti-VEGF were identified. Hospital admissions and outpatient visits were highest in patients with DME, while the number of licensed anti-VEGF injections in those with DME was about half that of those with nAMD (2.1 vs 3.9 per patient per year). Mean 1-year medical costs were also higher in patients with DME (US$6723) than in those with DM without retinopathy (US$2687) and nAMD (US$4980). In a multivariable analysis with matched cohorts, DME was associated with 66% higher medical costs for comorbid diseases (adjusted OR (aOR), 1.66; 95% CI 1.45 to 1.90) and 50% lower anti-VEGF injections (aOR, 0.50; 95% CI 0.46 to 0.54) compared with nAMD.ConclusionsThe overall HRU and economic burden for DME treated with anti-VEGF were higher than for DM without retinopathy or for nAMD treated with anti-VEGF. Meanwhile, the lower number of licensed anti-VEGF injections compared with nAMD may reflect a potential lack of ophthalmological treatment for DME supported by the NHI in Korea.

scholarly journals Healthcare resource use and costs of diabetic macular oedema for patients with antivascular endothelial growth factor versus a dexamethasone intravitreal implant in Korea: a population-based study

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e030930 ◽  
Author(s):  
HyunJeong Cho ◽  
Kyung Seek Choi ◽  
Joo Yong Lee ◽  
Donghwan Lee ◽  
Nam-Kyong Choi ◽  
...  
Keyword(s):  
Growth Factor ◽  
Healthcare Resource ◽  
Diabetic Macular Oedema ◽  
Eye Care ◽  
Dexamethasone Intravitreal Implant ◽  
Anti Vegf ◽  
Significant Difference ◽  
Intravitreal Implant ◽  
Antivascular Endothelial Growth Factor ◽  
Endothelial Growth Factor

ObjectivesTo estimate the costs and healthcare resources of patients with diabetic macular oedema (DME) who received intravitreal antivascular endothelial growth factor (anti-VEGF) agents or a dexamethasone intravitreal implant (DEX-implant) in Korea.DesignRetrospective cohort study.SettingThe Korean National Health Insurance claim data from 1 January 2015 to 30 June 2017 were retrieved from the Health Insurance Review and Assessment Service.ParticipantsAdult patients with DME who were diagnosed with diabetic retinopathy or DME and received ranibizumab, aflibercept or a DEX-implant in conjunction with intravitreal injection were included. Patients whose primary diagnoses were age-related macular degeneration or retinal vein occlusion were excluded.Main outcome measuresHealthcare resource utilisation and costs related to DME in the 12-month postindex period.ResultsDuring the study period, 182 patients and 414 patients were identified in the anti-VEGF and DEX-implant groups, respectively, and there was no significant difference in the demographic characteristics between the two groups. The outpatient eye care-related medical costs were US$3002.33 for the anti-VEGF group vs US$2250.35 for the DEX-implant group (p<0.0001). After adjusting the relevant covariates based on the generalised linear model, the estimated outpatient eye care-related medical costs were 33% higher in the anti-VEGF group than in the DEX-implant group (p<0.0001, 95% CI 22% to 45%). The utilisation pattern of the two groups showed no significant difference except for the number of intravitreal injections, which was higher in the anti-VEGF group (2.69±2.29) than in the DEX-implant group (2.09±1.37, p<0.001).ConclusionThe average annual eye-related medical cost of the DEX-implant group was significantly lower than that of the anti-VEGF group during the study period, which was mainly due to decreased utilisation of eye care-related injections. Further long-term studies are needed.

Long‐term follow‐up of antivascular endothelial growth factor treatment for diabetic macular oedema: a four‐year real‐world study

2019 ◽  
Vol 98 (4) ◽  
pp. 360-367
Author(s):  
Elisabet Granstam ◽  
Andreas Rosenblad ◽  
Aseel Modher Raghib ◽  
Therese Granström ◽  
Jan W. Eriksson ◽  
...  
Keyword(s):  
Growth Factor ◽  
Real World ◽  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Antivascular Endothelial Growth Factor ◽  
Long Term Follow Up ◽  
Endothelial Growth Factor ◽  
Growth Factor Treatment

scholarly journals Comparing vision and macular thickness in neovascular age-related macular degeneration, diabetic macular oedema and retinal vein occlusion patients treated with intravitreal antivascular endothelial growth factor injections in clinical practice

2021 ◽  
Vol 6 (1) ◽  
pp. e000749
Author(s):  
Rajya L Gurung ◽  
Liesel M FitzGerald ◽  
Bennet J McComish ◽  
Alex W Hewitt ◽  
Nitin Verma ◽  
...  
Keyword(s):  
Growth Factor ◽  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Age Related Macular Degeneration ◽  
Vein Occlusion ◽  
Age Related ◽  
Antivascular Endothelial Growth Factor ◽  
Endothelial Growth Factor ◽  
Median Change ◽  
Number Of Injections

ObjectiveTo compare the visual outcomes of intravitreal antivascular endothelial growth factor (anti-VEGF) injections in neovascular age-related macular degeneration (nAMD), diabetic macular oedema (DMO) and retinal vein occlusion (RVO) in a real-world setting.Methods and analysisRetrospective analysis of data from the Tasmanian Ophthalmic Biobank database. The median change in best-corrected visual acuity (BCVA) between baseline and 12 months post initiating intravitreal anti-VEGF treatment were compared between the three diseases. Final BCVA, central macular thickness (CMT), cumulative number of injections and overall predictors of change in BCVA and CMT were also determined.ResultsAt 12 months, change in BCVA was significantly different between nAMD, DMO and RVO cohorts (p=0.032), with lower median change for DMO (2 letters, range −5 to 20) than for RVO (11 letters, range −20 to 35). Likewise, CMT change was significantly different between the three cohorts (p=0.022), with a smaller reduction in CMT in DMO (−54 µm, range −482 to 50) than RVO patients (−137 µm, range −478 to 43; p=0.033). Total number of injections received (p=0.028) and final BCVA score (p=0.024) were also significantly different between the groups. Baseline BCVA was a negative predictor (p=0.042) and baseline CMT a positive predictor (p<0.001) of outcome. After adjusting for baseline BCVA and CMT, diagnosis of nAMD or RVO was a predictor of visual improvement compared with the DMO.ConclusionsAt the end of 12 months, nAMD and RVO cohorts had the greatest improvement in BCVA, however the final BCVA for DMO was significantly better than for nAMD.

scholarly journals Non-compliance among diabetic macular oedema patients on antivascular endothelial growth factor therapy in Malaysia

2021 ◽  
Vol 3 (2) ◽  
pp. 91-100
Author(s):  
Yew Meng Wong ◽  
Eve Lyn Chong ◽  
Vanessa Yung Ling Yeo
Keyword(s):  
Growth Factor ◽  
Macular Oedema ◽  
Treatment Options ◽  
Diabetic Macular Oedema ◽  
Standard Of Care ◽  
Dropout Rate ◽  
Common Reason ◽  
Poor General Health ◽  
Anti Vegf ◽  
Endothelial Growth Factor

Introduction: Diabetic macular oedema (DMO) is a major cause of visual loss in the diabetic population. There are several treatment options for DMO, including intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections, which have been shown to improve visual outcomes. Good compliance to treatment regimens is associated with greater visual benefit. Purpose: To estimate dropout rates and the associated reasons among DMO patients on three different anti-VEGF treatments. Study design: A retrospective review of patients with DMO who were on bevacizumab, ranibizumab and aflibercept therapy from January 2014 to December 2016. Materials and methods: Patients with DMO on anti-VEGF treatment in a private ophthalmology center were identified via an electronic database. Data on Malaysian residents aged 18 years or older were included. Foreign residents, the deceased, and those whose care had been transferred to another center were excluded from further analysis. Telephone interviews were then conducted with these patients based on a standard questionnaire to identify reasons for non-compliance. Results: This study included 134 patients. The overall lost to follow-up rate was 56.0% (75/134). After excluding the deceased, those who opted for treatment at an alternative center, and uncontactable patients, 47 (35.1%) were then identified as drop-outs. Financial constraint was the most common reason cited by 38.3% patients (18/47) and was highest in the bevacizumab group (88.9%, 16/18). The second most common reason was lack of perceivable change in vision (25.5%). In addition, 19.1% opted to stop treatment due to logistical difficulties and 12.8% of patients were satisfied with their stable visual acuity. Lastly, 4.3% were unable to continue with treatment due to poor general health. Conclusion: The dropout rate of 35.1% is higher than in previous publications from other countries. This study clarifies the challenges face by some Malaysian patients in seeking treatment for what is often a chronic disease. These results have implications on designing ways to assist patients’ cooperation with the standard of care.

Intravitreal antivascular endothelial growth factor in diabetic macular oedema: scoping review of clinical practice guidelines recommendations

2021 ◽  
pp. bjophthalmol-2021-319504
Author(s):  
Manuel Vargas-Peirano ◽  
Catalina Verdejo ◽  
Laura Vergara-Merino ◽  
Cristóbal Loézar ◽  
Martin Hoehmann ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Growth Factor ◽  
Diabetic Macular Oedema ◽  
Poor Quality ◽  
Quality Of Reporting ◽  
Agree Ii ◽  
Anti Vegf ◽  
Antivascular Endothelial Growth Factor ◽  
Endothelial Growth Factor

BackgroundDiabetic macular oedema (DME) is a worldwide major cause of low vision and blindness. Intravitreal antivascular endothelial growth factor (anti-VEGF) constitutes an effective treatment. Clinical practice guidelines (CPGs) are synthesis documents that seek to improve patient care.ObjectivesTo identify CPGs that make anti-VEGF recommendations for DME and to assess their reporting quality and their considerations when making recommendations.Eligibility criteriaCPGs published between December 2009 and December 2019 that make explicit anti-VEGF recommendations in DME.Sources of evidenceSensitive search strategy in Embase, Google Scholar and hand-searching on 165 websites.MethodsWe extracted information from each CPG with a previously piloted sheet. Two independent authors applied theAppraisal of Guidelines, Research and Evaluation tool (AGREE-II) assessment for each CPG.ResultsThe 21 included CPGs recommend anti-VEGF for DME, but there is a wide variation among the clinical aspects included, such as location of DME, visual acuity required, therapeutical alternatives or discontinuation. Most have a poor quality of reporting based on the AGREE-II tool assessment, especially those developed by ophthalmological societies, those that have an exclusive content about DME, and those where most of their authors disclose conflict of interest (COI) with pharmaceutical industry or where their authors did not report COIs. Pharmaceutical-sponsored CPGs did not use systematic reviews (SRs) to support their recommendations. Very few recommendations consider patient values and preferences, equity, acceptability and feasibility of the intervention.ConclusionsMost of the CPGs that made recommendations of anti-VEGF for DME have poor quality of reporting, do not use SRs and do not consider patients’ values and preferences.

scholarly journals Hyperreflective foci in predicting the treatment outcomes of diabetic macular oedema after anti-vascular endothelial growth factor therapy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chu-Hsuan Huang ◽  
Chang-Hao Yang ◽  
Yi-Ting Hsieh ◽  
Chung-May Yang ◽  
Tzyy-Chang Ho ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Visual Acuity ◽  
Growth Factor ◽  
Treatment Response ◽  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Vascular Endothelial ◽  
Outer Retina ◽  
Hyperreflective Foci ◽  
Endothelial Growth Factor

AbstractThis retrospective study evaluated the association of hyperreflective foci (HRF) with treatment response in diabetic macular oedema (DME) after anti-vascular endothelial growth factor (VEGF) therapy. The medical records, including of ophthalmologic examinations and optical coherence tomography (OCT) images, of 106 patients with DME treated with either intravitreal ranibizumab or aflibercept were reviewed. The correlations between best-corrected visual acuity (BCVA) changes and HRF along with other OCT biomarkers were analysed. The mean logMAR BCVA improved from 0.696 to 0.461 after an average of 6.2 injections in 1 year under real-world conditions. Greater visual-acuity gain was noted in patients with a greater number of HRF in the outer retina at baseline (p = 0.037), along with other factors such as poor baseline vision (p < 0.001), absence of epiretinal membrane (p = 0.048), and presence of subretinal fluid at baseline (p = 0.001). The number of HRF after treatment was correlated with the presence of hard exudate (p < 0.001) and baseline haemoglobin A1C (p = 0.001). Patients with proliferative diabetic retinopathy had greater HRF reduction after treatment (p = 0.018). The number of HRF in the outer retina, in addition to other baseline OCT biomarkers, could be used to predict the treatment response in DME after anti-VEGF treatment.

Comparative effectiveness and harms of intravitreal antivascular endothelial growth factor agents for three retinal conditions: a systematic review and meta-analysis

2018 ◽  
Vol 103 (4) ◽  
pp. 442-451 ◽  
Author(s):  
Allison Low ◽  
Ambar Faridi ◽  
Kavita V Bhavsar ◽  
Glenn C Cockerham ◽  
Michele Freeman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Visual Acuity ◽  
Growth Factor ◽  
Adverse Events ◽  
Meta Analysis ◽  
Diabetic Macular Oedema ◽  
Age Related Macular Degeneration ◽  
Age Related ◽  
Antivascular Endothelial Growth Factor ◽  
Endothelial Growth Factor

Intravitreal antivascular endothelial growth factor (VEGF) agents are widely used to treat ocular conditions but the benefits and harms of these treatments are uncertain. We conducted a systematic review to compare the effects of aflibercept, bevacizumab and ranibizumab on best-corrected visual acuity (BCVA) changes, quality of life and ocular or systemic adverse events in patients with neovascular age-related macular degeneration (NVAMD), diabetic macular oedema (DME) and central or branch retinal vein occlusion (RVO). We searched published and unpublished literature sources to February 2017 for randomised controlled trials and cohort or modelling studies reporting comparative costs in the USA. Two reviewers extracted data and graded the strength of the evidence using established methods. Of 17 included trials, none reported a clinically important difference (≥ 5 letters) in visual acuity gains between agents. Nine trials provide high-strength evidence of no difference between bevacizumab and ranibizumab for NVAMD. Three trials provide moderate-strength evidence of no difference between bevacizumab and ranibizumab for DME. There was low-strength evidence of similar effects between aflibercept and ranibizumab for NVAMD, aflibercept and bevacizumab for RVO and all three agents for DME. There was insufficient evidence to compare bevacizumab and ranibizumab for RVO. Rates of ocular adverse events were low, and systemic harms were generally similar between groups, although 1 DME trial reported more arterial thrombotic events with ranibizumab versus aflibercept. Overall, no agent had a clear advantage over another for effectiveness or safety. Aflibercept and ranibizumab were significantly less cost-effective than repackaged bevacizumab in two trials. Systematic review registration number: CRD42016034076.

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