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Table 3 Studies on impact of anti-VEGF treatment on costs and resource use

From: Anti-vascular endothelial growth factor in neovascular age-related macular degeneration – a systematic review of the impact of anti-VEGF on patient outcomes and healthcare systems

Study

Study population

Study design

Outcomes measure(s)/definition

Key finding(s)

Trend of increasing costs

 Campbell et al. [41]

Canada; Ontario Health Insurance Plan

Claims analysis

Total drug costs (anti-VEGF) for Ontario and Canada (2005–2007).

Increase of 8-fold between September 2005 and November 2007

This rapid increase preceded the availability of ranibizumab, strongly suggesting that off-label intravitreal injection of bevacizumab has been highly prevalent

 Coleman et al. [51]

 (abstract)

US Medicare beneficiaries (5% sample, n = 6290)

Claims analysis

Total eye-related Medicare costs per patient for 5-year study period (1995–1999) based on reimbursed eye-related professional fees; costs of treatment before introduction of PDT and anti-VEGF

Mean (SD): 2371 (2449); median $1607

 Day et al. [49]

US Medicare beneficiaries

Claims analysis

Distribution of mean Medicare payments for nAMD (1994, 2000, 2006)

Increase of costs largely due to anti-VEGF; dramatic rise between 2004 and 2006 then plateaued

Diagnosis more than doubled between 1994 and 2006

 Kume et al. [48]

Japanese patients with employee health insurance

Claims analysis

Medical expenses per 10,000 patients (2005–2013)

Increase of 9-fold over 9 years, from $1530 to $13,700

Increase of AMD patients by 300%

 Qualls et al. [50]

US Medicare beneficiaries

Claims analysis

Direct medical costs per patient/per case, 1 year before and after the index year (2004–2008)

Costs rose from 2004 to 2006, then plateaued

Costs in 2008 cohort were 50% higher than in 2004

Costs attributable to anti-VEGF injections: 4% in 2004; 75% in 2008 cohort

 Rosenfeld et al. [52]

US Medicare and Medicaid

Claims analysis

Total drug costs (anti-VEGF) for Medicare/Medicaid population (2008–2015)

Increase of 2-fold over 8 years, due to an increased number of nAMD patients being treated with anti-VEGF

Cost savings

 Hanemoto et al. [42]

Patients and their private caregivers from one hospital in Japan

Cross-sectional survey

Mean estimated total annual caregiving costs

90,327.11 ¥ total annual costs

Treatment via T&E rather than PRN reduced number of hospital visits, a reduction in caregiver burden (time, costs, and emotional impact)

 Windsor et al. [43]

US Medicare beneficiaries

Cohort

Medicare reimbursement rate; actual Medicare spending (2008–2015)

$9.0 billion of government savings by using OCT guided anti-VEGF therapy

Cost estimates reported per country

 Campbell et al. [41]

Canada; Ontario Health Insurance Plan

Claims analysis

Total drug costs (anti-VEGF) for Ontario and Canada (2005–2007)

Projected total cost (of anti-VEGF drugs) in Canada (2007):

• Bevacizumab: $2,769,000

• Ranibizumab: $180,000,000

 Fabiano et al. [44]

Patients from five hospitals in Italy

Clinical database

Mean per-capita costs of treatment and specialist (2016)

2536 € (treated < 1 year) 1839 € (treated > 1 year)

 Kiss et al. [53]

 (abstract)

US Patients (data source not reported)

Claims analysis

Mean annual costs per patient (2011–2015)

Treatment = naïve patients

• First year with intravitreal aflibercept vs ranibizumab: $10,417 vs $11,032;

• First 2 years: $15,410 vs. $15,393 Previously treated patients

• First year with intravitreal aflibercept and ranibizumab: $11,521 vs $11,589

• First 2 years: $19,202 vs $18,548

 Matamoros et al. [45]

French patients who are members of Association DMLA/Retina France

Cross-sectional survey

Mean cost per year per patient/net annual cost for patient (2012–2013)

1741 € (SD 3397 €, range 0–3176)

 Qualls et al. [50]

US Medicare beneficiaries

Claims analysis

Direct medical costs per patient/per case, 1 year before and after the index year (2004–2008)

Costs rose between 2004 and 2006, then plateaued.

Costs in 2008 cohort were 50% higher than in 2004.

Costs attributable to anti-VEGF injections: 4% in 2004; 75% in 2008 cohort

 Rosenfeld et al. [52]

US Medicare and Medicaid

Claims analysis

Total drug costs (anti-VEGF) for Medicare/Medicaid population (2008–2015)

Total annual drug costs in 2008:

• Intravitreal aflibercept: not applicable

• Bevacizumab: $35,502,851 (583,351 doses)

• Ranibizumab: $704,066,862 (327,663 doses)

Total annual drug costs in 2015:

• Intravitreal Aflibercept: $1,738,642,274 (836,425 doses)

• Bevacizumab: $89,488,151 (1,225,348 doses)

• Ranibizumab: $1,133,896,626 (542,820 doses)

 Schmidt et al. [47]

Patients of largest public ophthalmologic clinic in Switzerland

Claims analysis

Total healthcare costs per patient/per month, directly attributed to anti-VEGF therapy (2006–2014)

2186.98 CHF (95% CI: 1184.58 to 3189.38)

In the subgroup of patients with AMD, the costs for ophthalmologic treatment sank by 97.23 CHF/year (95% CI, 985.38–790.92; P = 0.829)

 Shalaby et al. [46]

Patients from UK NHS ophthalmological units (189 requests; 95.8% responses)

Cross-sectional request

Estimated annual costs of anti-VEGF drugs (incl. VAT) (2015)

Total: £539,764,992

Bevacizumab only: £729,500

  1. Abbreviations: AMD age-related macular degeneration, CHF Swiss franc, CI confidence interval, DMLA La Dégénérescence Maculaire Liée à l’Age, nAMD neovascular AMD, OCT optical coherence tomography, PDT photodynamic therapy, PRN as needed, SD standard deviation, T&E treat-and-extend, UK United Kingdom, VAT value-added tax, VEGF vascular endothelial growth factor