Treatment Patterns and Health Care Costs for Age-Related Macular Degeneration in Japan: An Analysis of National Insurance Claims Data.

PURPOSE: To investigate changes in the proportion of patients with age-related macular degeneration (AMD) visiting hospitals and to investigate factors associated with AMD, treatments, and medical expenses, as well as the outlook for AMD in Japan using a large health insurance database. DESIGN: Analysis of national insurance claims data. PARTICIPANTS: People 40 years of age or older who were registered in the Japan Medical Data Center database. METHODS: Patients with AMD were identified from 2005 through 2013 based on International Classification of Diseases, 10th revision, diagnosis codes. Changes in patient proportions, treatment procedures, and medical expenses were investigated during the study period. The data for each year were compared after adjustment based on the 2010 Japanese population annual census. The outlook for patients with AMD was predicted based on the combination of data in 2013 and an official future population prediction report. MAIN OUTCOME MEASURES: Changes in treatment patterns and health care costs in Japan. RESULTS: A total of 3 401 299 participants were included in the analysis, and 3058 AMD patients were identified over the 9-year period. The proportion of patients with AMD increased significantly from 0.084% (95% confidence interval, 0.050%-0.119%) in 2005 to 0.26% (95% confidence interval, 0.24%-0.29%) in 2013 (P = 0.0001, Pearson correlation coefficient test). There were significantly more men than women (odds ratio, 1.25; 95% confidence interval, 1.14-1.37), and the proportion of patients with AMD increased rapidly with age. Photodynamic therapy was replaced by anti-vascular endothelial growth factor (VEGF) therapy as the predominant therapy from 2009 onward. Medical expenses per 10 000 persons increased from $1530 to $137 000 over the 9-year period. The proportion of AMD patients is predicted to increase in the future and will reach a maximum of 223 000 in 2035. CONCLUSIONS: The proportion of AMD patients visiting hospitals, medical expenses, and the frequency of anti-VEGF therapy increased significantly over the 9-year period. These increasing trends are predicted to continue in Japan.

Drug delivery systems for photodynamic therapy.

Photodynamic therapy (PDT) is a medical treatment in which a combination of a photosensitizing drug and visible light causes destruction of selected cells. Over the past two decades, photodynamic therapy has enjoyed a period of intense investigation, both in the laboratory and in the clinic. Although still widely considered to be an experimental technique, its status and value within modern clinical practice continues to grow. The PDT field has, to date, been dominated by a small number of pharmaceutical companies and inhabited almost exclusively by clinicians and those involved in fundamental scientific research. True pharmaceutical formulation development has been limited, to some extent, by financial constraints. If PDT is to realise its undoubted potential in clinical practice it is important that awareness of the need for appropriate photosensitizer delivery systems is raised. Accordingly, this article deals with the innovations pertaining to drug delivery systems for photodynamic therapy as disclosed in recent patent literature.

Increasing use of a new health technology during the wait for NICE guidance: findings from the third national tracker survey of photodynamic therapy.

BACKGROUND: Photodynamic therapy (PDT) is a relatively new treatment for neovascular age-related macular degeneration. Trial evidence suggests that repeated treatments with PDT can decrease the relative risk of a reduction in visual acuity over 2 years. Concerns raised over the clinical and cost effectiveness of the treatment prompted a technology appraisal by the National Institute for Clinical Effectiveness (NICE). Difficulties in assessing the possible benefit or otherwise of PDT have led to delays in the publication of guidance. During this time the introduction of PDT into the UK National Health Service (NHS) has continued. Over three annual tracker surveys, we describe trends in the provision of PDT in the NHS and potential difficulties in the implementation of NICE guidance. METHODS: We undertook surveys in each October of 2000, 2001 and 2002 of clinical directors or lead consultants in all NHS eye units. These sought data on which (if any) patients were referred or treated with PDT and the thresholds of support for the use of PDT. RESULTS: Response rates were 82 per cent, 79 per cent and 82 per cent. The proportion of units routinely providing PDT for patients with more than 50 per cent classic sub-foveal CNV increased from 8.5 per cent in 2000 to 31 per cent in 2002 (p <0.001). Units referring or treating no patients decreased from 35 per cent to 10 per cent between 2000 and 2002 (p <0.001). There was a significant fall in the proportion of units changing policies on provision between 2000-2001 and 2001-2002. The proportion of respondents requiring further evidence before supporting the use of PDT decreased from 33 per cent in 2000 to 20 per cent in 2002. CONCLUSION: There is evidence of a continuing growth in access to PDT in the absence of NICE guidance. Although 90 per cent of units offer some pathway to treatment important variations in reported provision remain. Given that PDT services are becoming established, there is a risk that clinical policy is determined by local service development as much as by national guidance.