Abstract
BackgroundAge-related macular degeneration (AMD) is a disease that causes damage in the macular region of the retina, leading to irreversible blindness. This study aims to understand the profile and care of patients with AMD and its cost at the Brazilian public health system to identify AMD-care needs.MethodsThis is a retrospective observational study of AMD with real-world data from the Brazilian public healthcare system, using DATASUS claim databases. Patients with AMD were selected from 01/Jan/2014 to 31/Jan/2020; had at least one claim of ICD10 code H35.3 (Degeneration of macula and posterior pole), and were submitted to one of two procedures exclusively available for AMD patients - optical coherence tomography (OCT) and medical treatment of retinal disease (antiangiogenic); aged ≥18 years at first ICD10 claim, and presenting at least 1 year of follow-up in the database. We described patients’ characteristics, healthcare resource utilization and cost, and the antiangiogenic intravitreal treatment received by AMD patients, including the number of doses and interval time between them.ResultsPatients searching for AMD treatment since 2014 were mostly females (59%), white (61%), and a mean age of 72 years. They were mainly located in the Southeast (87%), and few patients were found in the North (1%) and Central-West (1.5%) regions, probably reflecting where the Brazilian guideline to treat AMD (Protocolo Clínico e Diretrizes Terapêuticas - PCDT) was incorporated as routine care for AMD. The average antiangiogenic dose of 2.5 antiangiogenic therapies within a year was below the expected. Most injections had an interval time of 20 to 40 days between doses, although some patients were treated more than 100 days. Another setback is that patients traveled longer distances for OCT and antiangiogenic treatment than overall AMD-healthcare, between 10 and 100 km.ConclusionsAMD patients seem to be undertreated, as they receive a mean of 2.5 doses of antiangiogenic treatment within a year. Inequalities among regions are evident, as the Southeast and South regions comprise almost all patients receiving the treatment from the public health system, probably reflecting the region with more access to AMD care according to PCDT recommendations.
Highlights
Age-related macular degeneration (AMD) is a disease that causes damage in the macular region of the retina, leading to irreversible blindness
Rate of AMD patients was higher in the Southeast region, which represent the vast majority of the study population (87%); whereas very few cases were found in the other regions
AMD-patients were receiving antiangiogenic injection according to the Protocolo Clínico e Diretrizes Terapêuticas (PCDT) recommendation from 20 to 40 days between one dose to the following one, some patients were treated more than 100 days between doses (Table 6)
Summary
Age-related macular degeneration (AMD) is a disease that causes damage in the macular region of the retina, leading to irreversible blindness. Age-related macular degeneration (AMD) is a disease that causes damage in the macular region of the retina [1], responsible for about 8% of severe visual impairment and irreversible blindness [2]. Treatment is currently available only for nAMD [7, 9], and requires multiple visits to a healthcare center per year, which causes a burden for the patient due to the reduced quality of life, higher life stress and lower satisfaction [7], and for the health system due to economic aspects [7, 10]. Healthcare in Brazil is mainly delivered by the Brazilian Unified Health System (Sistema Único de Saúde [SUS]), which provides access to healthcare services free of charge to the entire population, though around 75% use it exclusively
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