Natural Course of Patients Discontinuing Treatment for Age-Related Macular Degeneration and Factors Associated With Visual Prognosis

Kim, Jae Hui; Chang, Young Suk; Kim, Jong Woo

doi:10.1097/iae.0000000000001494

Cited by 37 publications

(43 citation statements)

References 31 publications

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“…In fact, Jeong et al reported that 77% of patients received ranibizumab more than 4 times a year and 35% of patients received ranibizumab more than 10 times a year. In other retrospective studies which used Korean hospital data between September 2009 and January 2014, a similar analysis period with our study, the average number of ranibizumab injections were reported as 4.0–4.5 per year [21, 22].…”

Section: Discussionsupporting

confidence: 70%

Incremental economic burden associated with exudative age-related macular degeneration: a population-based study

Kim

Park

Byun

et al. 2019

BMC Health Serv Res

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BackgroundThe exudative age-related macular degeneration (AMD) causes considerable healthcare costs for patients and healthcare system, which are expected to grow as the population ages. The objective of this study was to assess the incremental economic burden of exudative AMD by comparing total healthcare costs between the exudative AMD group and non-AMD group to understand economic burden related to exudative AMD.MethodsThis retrospective cohort study used the National Health Insurance Service database including the entire Korean population. Exudative AMD group included individuals with at least one claim for ranibizumab and one claim using the registration code for exudative AMD (V201). Non-AMD group was defined as individuals without any claims regarding the diagnostic code of H35.3 or ranibizumab. The exudative AMD group and non-AMD group were matched using a propensity-score model. Incremental healthcare resource utilization and healthcare costs were measured during a one-year follow-up by employing econometric models: ordinary least squares (OLS) with log transformation and heteroscedastic retransformation; and generalized linear model (GLM) with a log link function and gamma distribution.ResultsA total of 7119 exudative AMD patients were matched to 7119 non-AMD patients. The number of outpatient visits was higher in the exudative AMD group (P-value < 0.0001), while the length of hospitalization was shorter in exudative AMD group (P-value < 0.0001). Exudative AMD patients had total costs 2.13 times (95%CI, 2.08–2.17) greater than non-AMD group using OLS, and total costs 4.06 times (95%CI, 3.82–4.31) greater than non-AMD group using GLM. Annual incremental total costs were estimated as $5519 (OLS) and $3699 (GLM).ConclusionsExudative AMD was associated with significantly increased healthcare costs compared to the non-AMD group. Attention is needed to manage the socioeconomic burden of exudative AMD.

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Section: Discussionsupporting

confidence: 70%

Incremental economic burden associated with exudative age-related macular degeneration: a population-based study

Kim

Park

Byun

et al. 2019

BMC Health Serv Res

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“…The studies were mainly European and US-based, with a predominantly Caucasian population; only three reports involved patients from Asian countries. 17 , 18 , 19 The majority of studies assessed patients treated with intravitreal ranibizumab on a PRN dosing regimen, with a few more recent studies including intravitreal aflibercept or ranibizumab on a T&E regimen, Table 2 . This reflects the timing of treatment initiation of these patients, with most receiving their first anti-VEGF injection prior to 2013 (eTable 3, Supplementary materials).…”

Section: Resultsmentioning

confidence: 99%

“… 16 , 20 , 21 Synonyms used for non-adherence included ‘non-compliance’, 22 , 23 ‘absenteeism’ 24 or ‘non-attendance’. 25 Synonyms for non-persistence included ‘treatment discontinuation/cessation’ 18 , 26 , 27 or ‘lost to follow up’…”

Section: Resultsmentioning

confidence: 99%

“… Treatment discontinuation before 12 months, 30 study period 26 , 27 or permanently 31 No treatment or visit at clinic for more than 4 months 32 , 6 months 15 , 33 , 34 or 12 months 35 , 36 No follow up by any ophthalmologist for 3 months 28 No follow up within a 12 months period after receiving at least 1 anti-VEGF injection 37 Loss of follow up of at least 24 months 18 …”

Section: Resultsmentioning

confidence: 99%

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Nonadherence or Nonpersistence to Intravitreal Injection Therapy for Neovascular Age-Related Macular Degeneration

et al. 2021

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Topic Systematic review of risk factors for non-adherence and non-persistence to intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection therapy for neovascular age-related macular degeneration (nAMD). Clinical Relevance Lack of adherence (non-adherence) or under-treatment (non-persistence) with respect to evidence from clinical trials remains a significant barrier to optimizing real-world outcomes for patients with nAMD. Contributing factors and strategies to address this are poorly understood. Methods Studies that reported factors for non-adherence and/or non-persistence to anti-VEGF therapy as well as studies examining strategies to improve this were included. Trial eligibility and data extraction were conducted according to Cochrane review methods. Risk of bias was assessed using the Mixed Method Assessment Tool and certainty of evidence evaluated according to the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative Research) tool. Data were collated descriptively. Results Of the 1284 abstract results screened, 124 articles were assessed in full and 37 studies met the inclusion criteria. Definitions of non-adherence and non-persistence varied or were not reported. Non-persistence occurred early with up to 50% of patients stopping treatment by 24 months. High rates of non-adherence were similarly reported, occurring in 32 – 95% of patients. Certainty of this finding was downgraded to moderate level due to heterogeneity in definitions used across studies. Multiple factors determine non-adherence and non-persistence, including at condition, therapy, patient, social/economic and health systems/health-care team level. Moderate quality evidence points to lower baseline vision and poorer response to treatment as condition-related variables. The effects of other factors were of lower certainty, predominantly due to small numbers and potential biases in retrospective assessment. Although many factors are non-modifiable (e.g., patient co-morbidity), other factors are potentially correctable (e.g., lack of transport or mismatched patient expectations). Evidence on strategies to improve adherence and persistence is limited, but where available, these have proven effective. Conclusions Awareness of factors related to poor patient adherence and persistence in nAMD could help identify at-risk populations and improve real world outcomes. Further work is required to develop uniform definitions as well as establishing high quality evidence on interventions that can be easily implemented.

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“…The frequency of the problem as well as the consequences can vary considerably between the diseases. For example, a stop of treatment can quickly endanger the eyesight in nAMD [22] and proliferative diabetic retinopathy [23].…”

Section: Non-adherence and Non-persistencementioning

confidence: 99%

Systematic review: non-adherence and non-persistence in intravitreal treatment

Ehlken

Ziemssen

Eter

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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Purpose Intravitreal injection of VEGF inhibitors has become the standard of care for different macular diseases within the last years resulting in improved visual outcomes. Under real-life conditions, however, the necessity for frequent retreatments and reexaminations poses a burden for patients and treatment centers. Non-adherence and non-persistence to intravitreal treatment may lead to inferior clinical outcomes, and knowledge of contributing factors is crucial to improve adherence. This systematic review analyzes current literature for potential factors involved in non-adherence and non-persistence. Methods A systematic search was conducted in PubMed and Embase including three different aspects of intravitreal injection therapy: (1) diseases with intravitreal injections as treatment, (2) intravitreal injection, and (3) aspects of therapy adherence or therapy persistence. Data from identified quantitative studies were further extracted and grouped according to WHO criteria (condition, socio-economy, therapy, patient, and health system). The methodological quality of identified studies was graded. Identified qualitative studies (i.e., interviews) were descriptively analyzed and their findings narratively reported. Results Twenty-four publications were included. In 16 of those publications, a quantitative data analysis was conducted, analyzing factors associated with non-adherence. Worse visual acuity at baseline and unfavorable development of visual acuity, higher age, and greater distance to the treatment center were associated with non-adherence, while there was inconsistent evidence for an association of comorbidity. In qualitative studies, high follow-up/treatment burden, fear and anxiety, disappointed patient expectations, and lack of motivation to continue treatment were reported as reasons for non-persistence. Conclusions Knowledge of potential barriers in IVT treatment may improve adherence and potentially clinical results. Improvements can be achieved particularly in the healthcare complex (organizational improvements) and the “patient” complex by establishing realistic expectations. Recurrent education of the patient may be necessary.

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Natural Course of Patients Discontinuing Treatment for Age-Related Macular Degeneration and Factors Associated With Visual Prognosis

Cited by 37 publications

References 31 publications

Incremental economic burden associated with exudative age-related macular degeneration: a population-based study

Incremental economic burden associated with exudative age-related macular degeneration: a population-based study

Nonadherence or Nonpersistence to Intravitreal Injection Therapy for Neovascular Age-Related Macular Degeneration

Systematic review: non-adherence and non-persistence in intravitreal treatment

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