RESUMEN
AIM: The aim of this study was to follow the instruments' pathways and cost each segment to calculate whether reusable or disposable ophthalmic instruments offer better value for money for intravitreal injections. METHODS: The cycles and costs of reusable and single-use disposable instruments used for intravitreal injections were mapped out, including purchase costs, transport to and from the place of use, opening and disposal, sterilisation, replacement, salary costs of staff involved, etc. results: The cost of using reusable instruments for intravitreal injections (NZ$29.00) was lower than the cost of using disposable instruments ($30.51) by $1.51 per patient. CONCLUSIONS: Intravitreal injections performed with reusable instruments offer better value for money than when performed with disposable instruments. This equates to a beneficial financial saving just for this one low-complexity case. Such savings can multiply significantly when considering the instruments used in a wider variety of ophthalmic procedures. There are of course trade-offs between safety, quality, cost and sustainability.
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Equipos Desechables , Equipo Reutilizado , Inyecciones Intravítreas , Inyecciones Intravítreas/instrumentación , Inyecciones Intravítreas/economía , Equipos Desechables/economía , Humanos , Equipo Reutilizado/economía , Nueva Zelanda , Análisis Costo-BeneficioRESUMEN
PURPOSE/AIM OF THE STUDY: To quantify the cost of performing an intravitreal injection (IVI) utilizing activity-based costing (ABC), which allocates a cost to each resource involved in a manufacturing process. MATERIALS AND METHODS: A prospective, observational cohort study was performed at an urban, multi-specialty ophthalmology practice affiliated with an academic institution. Fourteen patients scheduled for an IVI-only visit with a retina ophthalmologist were observed from clinic entry to exit to create a process map of time and resource utilization. Indirect costs were allocated with ABC and direct costs were estimated based on process map observations, internal accounting records, employee interviews, and nationally-reported metrics. The primary outcome measure was the cost of an IVI procedure in United States dollars. Secondary outcomes included operating income (cost subtracted from revenue) of an IVI and patient-centric time utilization for an IVI. RESULTS: The total cost of performing an IVI was $128.28; average direct material, direct labor, and overhead costs were $2.14, $97.88, and $28.26, respectively. Compared to the $104.40 reimbursement set by the Centers for Medicare and Medicaid Services for Current Procedural Terminology code 67028, this results in a negative operating income of -$23.88 (-22.87%). The median clinic resource-utilizing time to complete an IVI was 32:58 minutes (range [19:24-1:28:37]); the greatest bottleneck was physician-driven electronic health record documentation. CONCLUSIONS: Our study provides an objective and accurate cost estimate of the IVI procedure and illustrates how ABC may be applied in a clinical context. Our findings suggest that IVIs may currently be undervalued by payors.
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Contabilidad/métodos , Asignación de Costos/economía , Costos de la Atención en Salud , Inyecciones Intravítreas/economía , Oftalmología/economía , Evaluación de Procesos, Atención de Salud/economía , Eficiencia Organizacional/economía , Recursos en Salud/economía , Humanos , Modelos Económicos , Admisión y Programación de Personal/economía , Estudios Prospectivos , Estados UnidosRESUMEN
Aim: To evaluate the cost-effectiveness of intravitreal aflibercept compared with macular laser photocoagulation and ranibizumab for diabetic macular edema (DME) in China. Methods: A Markov model was developed to reflect the vision changes in DME patients. Parameters were estimated from VIVID-EAST trial data, published literature and physician surveys. Results: In a 20-year horizon, intravitreal aflibercept was associated with 7.825 quality-adjusted life years (QALYs) and 217,841 Chinese Yuan Renminbi (CNY), laser photocoagulation was associated with 7.189 QALYs and 135,489 CNY, and ranibizumab was associated with 7.462 QALYs and 222,477 CNY. The incremental cost-effectiveness ratios were 129,397 CNY/QALY and -12,774 CNY/QALY for intravitreal aflibercept versus laser photocoagulation and ranibizumab, respectively. Conclusion: Intravitreal aflibercept was considered as a cost-effective strategy for DME when compared with laser photocoagulation; it was considered as a dominant strategy when compared with ranibizumab.
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Retinopatía Diabética/tratamiento farmacológico , Inyecciones Intravítreas/economía , Edema Macular/tratamiento farmacológico , Receptores de Factores de Crecimiento Endotelial Vascular/administración & dosificación , Proteínas Recombinantes de Fusión/administración & dosificación , Inhibidores de la Angiogénesis/uso terapéutico , China , Análisis Costo-Beneficio , Retinopatía Diabética/complicaciones , Humanos , Edema Macular/complicaciones , Cadenas de Markov , Años de Vida Ajustados por Calidad de Vida , Ranibizumab/administración & dosificación , Proteínas Recombinantes de Fusión/economíaRESUMEN
PURPOSE: During the past decade, intravitreally administered biologic drugs have advanced the treatment of retinal diseases, such as wet age-related macular degeneration (AMD), diabetic macular oedema and retinal venous occlusions. The drugs as well as the necessary disease management imply considerable economic burden on healthcare systems. This Norwegian study documents the rates of use of intravitreal therapies and intercounty variation over a 5-year period. METHODS: We collected data from the Norwegian Patient Register for all episodes of care encompassing intravitreal therapy during the period 2011-2015. For each episode, we received information on patient age, sex, county of residence, diagnosis and name of drug injected. RESULTS: During the study period, 21 277 patients had in total 236 857 episodes of care. The number of intravitreal injections doubled from 2011 to 2015, reaching 63 601 injections in 2015, of which 77% were for diagnosed wet AMD. In 2015, the age-adjusted number of episodes varied from 19 to 55 per 1000 population aged 50+ across Norway's 19 counties. The age-adjusted number of patients treated per 1000 population aged 50+ varied from 5.22 to 8.35. CONCLUSION: The use of intravitreal injections increased rapidly with wet AMD as the most frequent diagnosis and with varying utilization across Norway's 19 counties. The causes of the varying use of intravitreal therapies could not be established but may reflect variation in disease prevalence, treatment capacity, travel distance to the nearest ophthalmic service and lack of national treatment guidelines. The geographic variation in utilization may challenge policy goals of equitable care and warrants further studies.
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Inyecciones Intravítreas/estadística & datos numéricos , Enfermedades de la Retina/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Inhibidores de la Angiogénesis/uso terapéutico , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Inyecciones Intravítreas/economía , Masculino , Persona de Mediana Edad , Ranibizumab/uso terapéutico , Receptores de Factores de Crecimiento Endotelial Vascular/uso terapéutico , Proteínas Recombinantes de Fusión/uso terapéutico , Sistema de Registros , Enfermedades de la Retina/tratamiento farmacológico , Factor A de Crecimiento Endotelial Vascular , Adulto JovenRESUMEN
INTRODUCTION: Treatment of neovascular age-related macular degeneration (nAMD) has evolved with the advent of anti-vascular endothelial growth factor agents such that intravitreally administered aflibercept and ranibizumab (RBZ) have become the standard of care. Randomized clinical trials (RCTs) have demonstrated the benefits of these agents in nAMD; however, results achieved under RCT protocols may not always be replicated in clinical practice. Assessing real-world outcomes is important to estimate the effectiveness and cost-effectiveness of these two agents. Our objective was to assess the real-world effectiveness of intravitreally administered aflibercept and RBZ in treatment-naive patients with nAMD and determine the cost-effectiveness of intravitreally administered aflibercept versus RBZ in a real-world setting. METHODS: A multistage approach was undertaken. A systematic literature review (SLR) was completed to identify studies describing real-world outcomes in patients with nAMD treated intravitreally with aflibercept or RBZ. A meta-analysis of data identified in the SLR generated a pooled estimate of the effectiveness of intravitreally administered aflibercept and RBZ at 52 weeks and an estimate of treatment burden (injection frequency and monitoring). The impact of treatment effect modifiers, such as baseline visual acuity (VA) and age, were corrected through a multivariable meta-regression. A Markov state transition model was developed to estimate the real-world cost-effectiveness of intravitreally administered aflibercept using results from the pooled estimates for effectiveness and treatment burden as primary inputs. The analysis considered the perspective of the French National Healthcare System. RESULTS: Patients treated intravitreally with aflibercept had a mean age of 79.52 years and mean baseline VA of 55.80 Early Treatment Diabetic Retinopathy Study (ETDRS) letters. At week 52, mean VA gain was 5.30 ETDRS letters in patients reporting an average of 7.10 intravitreal injections of aflibercept and 8.65 visits (injection and/or monitoring). RBZ-treated patients were younger (77.28 years), with a lower mean baseline VA (52.81 ETDRS letters). At week 52, mean VA gain from baseline was 4.24 ETDRS letters, with an average of 5.88 injections and 10.10 visits (injection and/or monitoring). After correcting for differences in age (77.28 years) and baseline VA (52.81 ETDRS letters) and considering the current clinical practice with aflibercept and RBZ, the mean VA gain was 6.57 ETDRS letters for patients treated intravitreally with aflibercept and 4.42 ETDRS for patients treated intravitreally with RBZ. The cost-effectiveness analysis showed that intravitreally administered aflibercept is a more effective treatment option with an incremental gain in quality-adjusted life years (QALYs) (4.918 versus 4.880) and an incremental cost-effectiveness ratio (ICER) of 27,087 per QALY. CONCLUSIONS: The analysis identified differences in the overall treatment approach and how ophthalmologists use intravitreally administered aflibercept and RBZ in clinical practice. These differences ultimately influence the mean real-world effectiveness of the two agents. Intravitreal treatment with aflibercept (injection frequency and patients follow-up) was consistent and in line with the European label recommendations. Patients treated intravitreally with aflibercept in clinical practice reported a mean gain in VA of similar magnitude to the mean VA gain reported in the pivotal RCT. Conversely, treatment with RBZ varied significantly across the different studies. On average, RBZ-treated patients reported a low injection frequency and a frequent follow-up, driven in part by the high number of patients treated with pro re nata (PRN) regimens. RBZ-treated patients reported gains in VA versus baseline; however, the magnitude of the gain in VA was not comparable to the VA gains reported in the RBZ pivotal RCT. Intravitreal treatment with aflibercept was associated with better mean VA outcomes and an incremental gain in QALYs compared with RBZ and can be considered cost-effective for the treatment of nAMD in patients in France despite a higher price for each individual intravitreal injection of aflibercept compared with RBZ. FUNDING: Bayer AG, Basel.
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Inhibidores de la Angiogénesis/economía , Degeneración Macular/tratamiento farmacológico , Degeneración Macular/economía , Ranibizumab/economía , Proteínas Recombinantes de Fusión/economía , Anciano , Inhibidores de la Angiogénesis/uso terapéutico , Análisis Costo-Beneficio , Femenino , Humanos , Inyecciones Intravítreas/economía , Masculino , Ensayos Clínicos Controlados Aleatorios como Asunto , Ranibizumab/uso terapéutico , Receptores de Factores de Crecimiento Endotelial Vascular/uso terapéutico , Proteínas Recombinantes de Fusión/uso terapéutico , Resultado del Tratamiento , Factor A de Crecimiento Endotelial Vascular/uso terapéutico , Agudeza VisualRESUMEN
BACKGROUND: Antiangiogenic therapy has proved to be an important therapeutic tool for many retinal vascular diseases; however, its availability is limited in developing countries. This study sought to describe the bevacizumab vial sharing process and to evaluate the impact of this repackaging system on the costs incurred in a Brazilian public hospital. METHOD: This retrospective study compared the number and costs of intravitreal antiangiogenic injections approved via court order in the first year of the study (2015) to the number and costs of the bevacizumab injections provided through the use of vial sharing in the second year of the study (2016). Vial sharing consists of the traditional process used to repackage bevacizumab; in this case, however, the drug samples used were the residual volume from the preparation of bevacizumab for oncology patients. The hospital adhered to the guidelines established by the Brazilian Health Surveillance Agency (ANVISA). RESULTS: In the first year of the study and using medication obtained through court orders, 550 intravitreal injections were performed in the ophthalmology ambulatory care center. Based on local pricing tables, the total cost of the medication was BRL$1,036,056.25 (USD$267,546.58), and the average cost of each application was BRL$1883.74 (USD$486.45). In the second year of the study, 1081 intravitreal applications were performed at the same hospital using doses obtained through bevacizumab vial sharing. The total cost was BRL$21,942.49 (USD$5663.30) and the per-unit cost was BRL$20.30, or USD$5.23 (a savings of 97.88%). CONCLUSION: This study found that bevacizumab vial sharing led to a significant reduction in public health care costs associated with antiangiogenic treatment and increased the availability of the drug to public health care patients. These results can be extrapolated to other types of drugs and health care systems.
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Inhibidores de la Angiogénesis/economía , Bevacizumab/economía , Costos de los Medicamentos , Enfermedades de la Retina/tratamiento farmacológico , Enfermedades de la Retina/economía , Anciano , Inhibidores de la Angiogénesis/uso terapéutico , Bevacizumab/uso terapéutico , Brasil , Análisis Costo-Beneficio , Femenino , Costos de la Atención en Salud , Humanos , Inyecciones Intravítreas/economía , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
OBJECTIVES: To 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. DESIGN: Retrospective cohort study. SETTING: The Korean National Health Insurance claim data from 1 January 2015 to 30 June 2017 were retrieved from the Health Insurance Review and Assessment Service. PARTICIPANTS: Adult 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 MEASURES: Healthcare resource utilisation and costs related to DME in the 12-month postindex period. RESULTS: During 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). CONCLUSION: The 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.
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Inhibidores de la Angiogénesis/administración & dosificación , Inhibidores de la Angiogénesis/economía , Dexametasona/administración & dosificación , Retinopatía Diabética/tratamiento farmacológico , Retinopatía Diabética/economía , Implantes de Medicamentos/economía , Utilización de Instalaciones y Servicios/economía , Utilización de Instalaciones y Servicios/estadística & datos numéricos , Costos de la Atención en Salud , Recursos en Salud/economía , Recursos en Salud/estadística & datos numéricos , Edema Macular/tratamiento farmacológico , Edema Macular/economía , Ranibizumab/administración & dosificación , Ranibizumab/economía , Receptores de Factores de Crecimiento Endotelial Vascular/administración & dosificación , Proteínas Recombinantes de Fusión/administración & dosificación , Proteínas Recombinantes de Fusión/economía , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Adolescente , Adulto , Anciano , Estudios de Cohortes , Retinopatía Diabética/complicaciones , Femenino , Humanos , Inyecciones Intravítreas/economía , Edema Macular/complicaciones , Masculino , Persona de Mediana Edad , República de Corea , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVE: To assess the economic impact following the inclusion of an intravitreal implant of dexamethasone for the treatment of diabetic macular oedema in a healthcare area in Spain. METHOD: A 3-year budget impact model was designed to estimate healthcare direct costs for adult patients with diabetic macular oedema from the National Health System perspective. The approved therapies in use (aflibercept/ranibizumab/dexamethasone) were considered. The target population was estimated from published diabetic macular oedema prevalence (6.41%) and incidence (0.82%) for a population of 25,000 adults. Dexamethasone was assumed to be used annually in 20%, 30% and 40% of patients, respectively. Annual total costs included: drug acquisition (based on frequency of injections per every year, considering exfactory prices with mandatory deduction and split of vials), intravitreal administration, patient monitoring, management of cardiovascular and ocular adverse events (cataracts, increased intraocular pressure, endophthalmitis, vitreous haemorrhage and retinal detachment). Detailed resource consumption reflecting clinical practice was provided from local experts in retina and vitreous. Unitary costs (, 2016) were obtained from national databases and literature. Sensitivity analyses were performed to assess model robustness. RESULTS: The inclusion of intravitreal dexamethasone implant would lead to annual cost savings of 35,030 (-4.2%), 10,743 (-1.8%) and 5,051 (-0.9%), years 1-3 respectively. Total costs were reduced mainly by the fewer annual injections required by dexamethasone. The average annual incremental costs were -350, -96 and -41 per patient. CONCLUSIONS: The inclusion of an intravitreal dexamethasone implant for the treatment of diabetic macular oedema would lead to cost-savings for the considered health area, mainly by reducing the administration costs.
Objetivo: Determinar el impacto económico tras la inclusión del implante intravítreo de dexametasona para el tratamiento del edema macular diabético en un área sanitaria en España.Método: Se diseñó un modelo de impacto presupuestario a tres años para estimar los costes directos en pacientes adultos con edema macular diabético, desde la perspectiva del Sistema Nacional de Salud, considerando terapias intravítreas actualmente utilizadas (aflibercept/ranibizumab/dexametasona). La población diana se obtuvo a partir de la prevalencia (6,41%) e incidencia (0,82%) del edema macular diabético publicadas para una población de 25.000 pacientes adultos. Se asumió un 20%, 30% y 40% anual de pacientes tratados con dexametasona, respectivamente. El coste total incluyó: coste farmacológico (precio de venta del laboratorio con deducción obligatoria y fraccionamiento de viales, según frecuencia de inyecciones necesarias cada año de tratamiento), administración intravítrea, seguimiento de pacientes y manejo de eventos oculares (cataratas, hipertensión ocular, endoftalmitis, hemorragia intravítrea y desprendimiento de retina) y cardiovasculares. El consumo de recursos según la práctica habitual fue estimado por expertos en retina y vítreo. Los costes unitarios (, 2016) se obtuvieron de la literatura y de bases de datos nacionales. Los análisis de sensibilidad evaluaron la robustez del modelo. Resultados: La inclusión del implante intravítreo de dexametasona supondría reducciones de 35.030 (4,2%), 10.743 (1,8%) y 5.051 ( 0,9%) cada año, respectivamente, disminuyendo principalmente por el menor número anual de inyecciones requeridas con dexametasona. La reducción anual promedio supondría 350 , 96 y 41 por paciente.Conclusiones: La inclusión del implante intravítreo de dexametasona para el tratamiento del edema macular diabético supone ahorros para el área sanitaria considerada, fundamentalmente por la reducción de costes de administración.
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Antiinflamatorios/economía , Antiinflamatorios/uso terapéutico , Dexametasona/economía , Dexametasona/uso terapéutico , Complicaciones de la Diabetes/tratamiento farmacológico , Complicaciones de la Diabetes/economía , Edema Macular/tratamiento farmacológico , Edema Macular/economía , Cuerpo Vítreo , Anciano , Antiinflamatorios/administración & dosificación , Dexametasona/administración & dosificación , Implantes de Medicamentos/economía , Femenino , Costos de la Atención en Salud , Humanos , Incidencia , Inyecciones Intravítreas/economía , Edema Macular/etiología , Masculino , Persona de Mediana Edad , Modelos Económicos , Prevalencia , EspañaRESUMEN
Diabetic macular edema (DME) is one of the major causes of blindness, caused primarily by hyperglycemia and results from multiple pathological processes mostly secondary to increased levels of VEGF and other inflammatory cytokines. DME management includes control of systemic risk factors together with laser photocoagulation, frequent intraocular injections of anti-VEGF agents and steroids implants. Recent adoption of novel alternative drug delivery options has led to the development of sustained release ocular implants with longer duration of action with less injection frequency. This article will review the pharmacology and clinical data in terms of efficacy, safety and benefits of the sustained release steroid implants in treatment of DME with special emphasis on the fluocinolone acetonide ILUVIEN® implant.
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Inhibidores de la Angiogénesis/uso terapéutico , Retinopatía Diabética/tratamiento farmacológico , Fluocinolona Acetonida/administración & dosificación , Edema Macular/tratamiento farmacológico , Inhibidores de la Angiogénesis/economía , Catarata/inducido químicamente , Catarata/epidemiología , Ensayos Clínicos Fase II como Asunto , Análisis Costo-Beneficio , Preparaciones de Acción Retardada/administración & dosificación , Preparaciones de Acción Retardada/efectos adversos , Preparaciones de Acción Retardada/economía , Preparaciones de Acción Retardada/farmacocinética , Retinopatía Diabética/economía , Implantes de Medicamentos , Fluocinolona Acetonida/efectos adversos , Fluocinolona Acetonida/economía , Fluocinolona Acetonida/farmacocinética , Humanos , Presión Intraocular/efectos de los fármacos , Inyecciones Intravítreas/efectos adversos , Inyecciones Intravítreas/economía , Edema Macular/economía , Modelos Económicos , Calidad de Vida , Resultado del Tratamiento , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Agudeza Visual/efectos de los fármacosRESUMEN
BACKGROUND: Previous analyses of real-life data indicated that injection frequency and health care costs did not differ for anti-VEGF treatment with aflibercept and ranibizumab. The objective of this study was to investigate whether this finding persisted when analysing a longer time period after licensing. METHODS: Retrospective analysis of health insurance claims data of two large Swiss basic health insurance plans including 28% of the Swiss population. Patients qualified for inclusion if aflibercept or ranibizumab treatment had been initiated between June 1, 2013 and November 1, 2014. Within this set, patients with at least 12 months of continuous insurance enrolment in the previous year, 12-month follow-up, and without change of anti-VEGF drug were considered. We examined the distribution of demographic data and patient characteristics between those receiving ranibizumab and those receiving aflibercept. Numbers of injections and associated health care expenditures observed during the 12-month follow-up period after incident treatment were the two outcomes considered. In multivariate regression analyses, controlling for possible confounding factors, we compared differences in these two outcomes between patients treated with aflibercept as compared to ranibizumab. RESULTS: A total of 3'058 patients were analysed, 790 (26%) receiving aflibercept and 2`268 receiving ranibizumab (74%). The use of aflibercept (average number of injections 6.2) as compared to ranibizumab (average number of injections 5.7) in the follow-up period of 1 to 12 months, was associated with a 12% increase in the injection frequency (95% confidence interval (CI) 6-17%; p < 0.001). CONCLUSIONS: Real-life data contradicts the assumption that aflibercept is used less frequently as compared to ranibizumab. This results in similar total health care expenditures for both anti-VEGF agents.
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Costos de la Atención en Salud/estadística & datos numéricos , Inyecciones Intravítreas/estadística & datos numéricos , Degeneración Macular/tratamiento farmacológico , Receptores de Factores de Crecimiento Endotelial Vascular/administración & dosificación , Proteínas Recombinantes de Fusión/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Inhibidores de la Angiogénesis/administración & dosificación , Inhibidores de la Angiogénesis/economía , Femenino , Humanos , Inyecciones Intravítreas/economía , Degeneración Macular/economía , Masculino , Persona de Mediana Edad , Ranibizumab/administración & dosificación , Ranibizumab/economía , Proteínas Recombinantes de Fusión/economía , Estudios Retrospectivos , Suiza , Adulto JovenRESUMEN
OBJECTIVES: High-cost antivascular endothelial growth factor (anti-VEGF) medicines for eye disorders challenge ophthalmologists and policymakers to provide fair access for patients while minimising costs. We describe the growth in the use and costs of these medicines and measure inequalities in access. DESIGN: Longitudinal study using Hospital Episode Statistics (2005/2006 to 2014/2015) and hospital prescribing cost reports (2008/2009 to 2015/2016). We used Poisson regression to estimate standardised rates and explore temporal and geographical variations. SETTING: National Health Service (NHS) care in England. POPULATION: Patients receiving anti-VEGF injections for age-related macular degeneration, diabetic macular oedema and other eye disorders. INTERVENTIONS: Higher-cost drugs (ranibizumab or aflibercept) recommended by the National Institute for Health and Care Excellence or lower-cost drug (bevacizumab) not licensed for eye disorders. MAIN OUTCOME MEASURES: National procedure rates and variation between and within clinical commissioning groups (CCGs). Cost of ranibizumab and aflibercept prescribing. RESULTS: Injection procedures increased by 215% between 2010/2011 and 2014/2015. In 2014/2015 there were 388 031 procedures (714 per 100 000). There is no evidence that the dramatic growth in rates is slowing down. Since 2010/2011 the estimated cost of ranibizumab and aflibercept increased by 247% to £447 million in 2015/2016, equivalent to the entire annual budget of a CCG. There are large inequalities in access; in 2014/2015 procedure rates in a 'high use' CCG were 9.08 times higher than in a 'low use' CCG. In the South-West of England there was twofold variation in injections per patient per year (range 2.9 to 5.9). CONCLUSIONS: The high and rising cost of anti-VEGF therapy affects the ability of the NHS to provide care for other patients. Current regulations encourage the increasing use of ranibizumab and aflibercept rather than bevacizumab, which evidence suggests is more cost-effective. NHS patients in England do not have equal access to the most cost-effective care.
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Inhibidores de la Angiogénesis/economía , Costos de los Medicamentos/estadística & datos numéricos , Inyecciones Intravítreas/economía , Ranibizumab/economía , Proteínas Recombinantes de Fusión/economía , Anciano , Anciano de 80 o más Años , Inhibidores de la Angiogénesis/administración & dosificación , Análisis Costo-Beneficio , Retinopatía Diabética/tratamiento farmacológico , Costos de los Medicamentos/tendencias , Inglaterra , Femenino , Humanos , Inyecciones Intravítreas/tendencias , Estudios Longitudinales , Degeneración Macular/tratamiento farmacológico , Edema Macular/tratamiento farmacológico , Masculino , Ranibizumab/administración & dosificación , Receptores de Factores de Crecimiento Endotelial Vascular/administración & dosificación , Proteínas Recombinantes de Fusión/administración & dosificación , Factores Socioeconómicos , Medicina Estatal , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Factor A de Crecimiento Endotelial Vascular/economíaRESUMEN
AIMS: The aims were to compare a novel conjunctival mould used to assist the delivery of intravitreal drugs to a conventional technique with respect to patient, surgeon and cost benefit. METHODS: A prospective review of 200 intravitreal injections was undertaken, 100 using a 'conventional' freehand technique (group 1) and 100 using a novel conjunctival mould (group 2). Intraoperative visual analogue scale (VAS) pain scores, patient preference, surgeon perception of the ease of insertion of the conjunctival mould were recorded as well as a cost comparison. RESULTS: VAS pain score in the conventional group was 2.58 compared to 1.38 in the conjunctival mould group (p<0.01). The surgeon reported the insertion of the conjunctival mould as easy in 89 cases, moderate in 10 cases, and difficult in one case. The cost saving with a conjunctival mould pack compared to a conventional pack was £7.70; an annual saving of £19,250 for the trust. CONCLUSIONS: The reduction in the VAS pain score with the conjunctival mould was statistically significant (p<0.01). The surgeons found that the device, which was easy to insert, offered excellent globe stability and a safe, reproducible entry site and angle of needle insertion.
Asunto(s)
Inhibidores de la Angiogénesis/administración & dosificación , Anticuerpos Monoclonales Humanizados/administración & dosificación , Sistemas de Liberación de Medicamentos/instrumentación , Inyecciones Intravítreas/instrumentación , Degeneración Macular/tratamiento farmacológico , Costos y Análisis de Costo , Sistemas de Liberación de Medicamentos/economía , Diseño de Equipo , Dolor Ocular/diagnóstico , Humanos , Inyecciones Intravítreas/economía , Dimensión del Dolor , Prioridad del Paciente , Médicos/psicología , Estudios Prospectivos , Ranibizumab , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidoresRESUMEN
PURPOSE: To determine whether there is a difference in anesthetic effect between topical proparacaine drops, 4% lidocaine solution, or 3.5% lidocaine gel, and whether this has an impact on the overall injection experience. METHODS: One hundred and twenty sequential patients undergoing intravitreal injections were randomized to 1 of 3 groups: proparacaine 0.5% drops (Group 1), proparacaine + 4% lidocaine-soaked cotton tipped swabs (Group 2), or 3.5% lidocaine gel (Group 3). Discomfort associated with the lid speculum, with the needle, and with burning sensation was graded on a scale of 0 to 10 (0 = no pain, 10 = worst pain ever). The overall injection experience was graded as Excellent, Very Good, Fair, Poor, or Awful. RESULTS: The average lid speculum pain score for Group 1 was 0.85, Group 2 was 0.50, and Group 3 was 0.65 (P = 0.32). The average needle pain score for Group 1 was 1.78, Group 2 was 1.75, and Group 3 was 1.48 (P = 0.38). The average burning pain score for Group 1 was 1.45, Group 2 was 1.58, and Group 3 was 1.13 (P = 0.23). Overall satisfaction was rated as Excellent or Very Good in 95%, 97.5%, and 92.5% of Group 1, 2, and 3 patients, respectively (P = 0.64). CONCLUSION: The use of topical proparacaine drops provides very effective and cost-effective anesthesia during office-based intravitreal injections.
Asunto(s)
Anestésicos Locales/administración & dosificación , Inyecciones Intravítreas/métodos , Lidocaína/administración & dosificación , Propoxicaína/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Anestésicos Locales/economía , Costos de los Medicamentos , Femenino , Geles , Humanos , Inyecciones Intravítreas/efectos adversos , Inyecciones Intravítreas/economía , Lidocaína/economía , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Satisfacción del Paciente , Propoxicaína/economía , Estudios ProspectivosRESUMEN
The treatment of age-related macular degeneration with anti-VEGF medications has resulted not only in significant improvements in eye treatment but also in rising costs of ophthalmological therapy. This new treatment has been rapidly introduced into daily practice in Germany with its social security healthcare system and also in Great Britain with its National Health Service. In both countries the most prevalent treatment scheme currently includes three baseline injections of ranibizumab followed by additional injections depending on persisting disease activity.