Office Examinations–Directed Treatment Paradigms Reduce Travel Burden, Decrease Treatment Cost, and Improve Quality-Adjusted Life-Years for Patients With Exudative Age-Related Macular Degeneration Undergoing Antivascular Endothelial Growth Factor Therapy

Abstract

Purpose: In the United States, most intravitreal injections are performed the same day as an office examinations; however, federal agencies and insurance payers suggest these same-day examinations charges are overused and have recommended scrutiny. In this study, we estimate the cost vs benefit to society of same-day office examinations during intravitreal injections for wet age-related macular degeneration (wAMD). Methods: An Excel spreadsheet was used to model different antivascular endothelial growth factor treatment scenarios for wAMD, including automatic treatment, injection series' treat and extend (T&E), and as-needed treatment, with increasing same-day examinations in the order listed. Treatment parameters were estimated using US population statistics, published literature, and Centers for Medicare & Medicaid Services, provider utilization data. Costs and benefits were compared for the 4 treatment scenarios. Results: Although yearly examinations and optical coherence tomography costs were higher for injection series, T&E, and as-needed protocols compared with automatic treatment, our model predicts reduced yearly injection and travel costs for those same treatment scenarios also, saving $2.9 billion (injection series), $7.2 billion (T&E), and $6.1 billion (as-needed) annually for the US population. Same-day injections accounted for 21%, 8%, and 9% of the savings, respectively, because of reduced travel burden. Furthermore, early detection of wAMD in the fellow eye during office examinations allows for a 1.8, 2.1, and 2.5 quality-adjusted life-year benefit, respectively. Conclusions: Office examinations–directed antivascular endothelial growth factor therapy for wAMD reduces travel and treatment expenses and improves screening of the fellow eye, resulting in robust cost savings and quality-adjusted life-year benefit for the US population.

Intravitreal Injection Therapy: Current Techniques and Supplemental Services

“…With the tip of the needle safely positioned in the vitreous cavity, steady depression of the syringe plunger to inject 0.05to 0.1-mL volume is the safest way to deliver the drug, minimizing silicone oil droplets, 3 spikes in intraocular pressure (IOP), and vitreous reflux. 33 After injection, the syringe/needle is withdrawn and safely disposed of in a sharps container to be incinerated.…”

“…Clinicians' judgment aided by retinal diagnostic imaging allows therapy to be tailored to an individual patient's condition, improving efficiency and decreasing the treatment's burden to patients and the cost to the health care system. 3 Therefore, a full spectrum of intravitreal injection therapy includes scheduled "standard" injections and also more complex variations that require a multifaceted approach and deliberations prior to injection. The purpose of this document is to review intravitreal injection therapy and to discuss considerations for which additional services are appropriate.…”