PSS7 Real-World Analysis of the Pharmaco-Utilization of Intravitreal Vascular Endothelial Growth Factor (VEGF) Inhibitors and Healthcare Costs Among Patients with WET Age-Related Macular Degeneration (WAMD) in Italy

Abstract

To analyse the pharmaco-utilization of VEGF inhibitors and healthcare costs among wAMD-patients in Italian real-world settings. This retrospective observational analysis was based on administrative databases of 2 regions and 3 Local Health Units in Italy, accounting approximately 6million health-assisted individuals. Patients were included during January/2010—December/2017, if they were ≥50 years old and presented a prescription for VEGF inhibitors (aflibercept/pegaptanib/ranibizumab) and/or i)discharge diagnosis (ICD-9-CM-code=362.52) for wAMD or ii)injections of vitreous substitute (procedural/specialistic code=14.75). Patients with injections of vitreous substitute presenting diabetes diagnosis, dexamethasone intravitreal implant or diagnosis for other ophthalmic pathologies with indications for intravitreal treatments were excluded. Patients were followed-up from index-date (corresponding to the first match with inclusion criteria) to December 2018. Pharmaco-utilization and cost analyses were performed only on alive patients prescribed VEGF inhibitors. Preliminary results showed that 1,287 wAMD-patients were included (51.6% male). Mean age±SD was 73.4±9.8. Patients’ distribution by age decades was: 10.7% in 50-59 age decade, 21.9% in 60-69, 38.2% in 70-79,29.2% ≥80 years old. Mean follow-up length was 4.0±2.1 years; during this time, 153 (11.9%) patients died. VEGF inhibitors were prescribed to 795 patients: 204 (25.7%) aflibercept, 14 (1.8%) pegaptanib, 577 (72.6%) ranibizumab. Mean number of VEGF inhibitor prescriptions decreased during follow-up: 3.6±2.0 (4.0±1.9 aflibercept, 3.6±2.1 pegaptanib, 3.4±2.0 ranibizumab) during 1st year, 1.1±1.9 (0.9±1.5 aflibercept, 0.4±0.9 pegaptanib, 1.2±2.0 ranibizumab) for 2nd year and 0.9±1.8 (0.1±0.5 aflibercept, none pegaptanib, 1.0±1.9 ranibizumab) for 3rd year. During 1st year of follow-up, mean healthcare costs were €6,075.88 for aflibercept-users, €7,737.70 for pegaptanib-users and €5,894.80 for ranibizumab-users. 72.3% of treatment costs per patient prescribed VEGF inhibitor was related to VEGF inhibitor therapies. Treatment costs were €3,545.09(aflibercept-users), €3,212.92(pegaptanib-users), €3,446.13(ranibizumab-users). VEGF inhibitors prescriptions were observed to decrease over time, suggesting a trend of under-treatment among wAMD-patients analysed that could ultimately lead to the worsening of clinical outcomes and higher consumption of healthcare resources.