Rapid Expansion of Intravitreal Drug Injection Procedures, 2000 to 2008

Abstract

To evaluate patterns of care for age-related macular degeneration following the introduction of vascular endothelial growth factor inhibitors. Methods: Using a population-based retrospective design, we studied monthly fee claims for intravitreal injections submitted to the Ontario Health Insurance Plan between January 1, 2000, and March 30, 2008, and linked procedures to the physicians who performed them. This database records physician services provided as part of universal health care insurance coverage in Ontario, Canada. This program covers all residents of Ontario, which had an average population of 12.1 million during the study period. Results: Following regulatory approval of bevacizumab for colorectal cancer in 2005, off-label use of this drug for the treatment of retinal disease, particularly agerelated macular degeneration, became increasingly common. The rate of intravitreal injections in Ontario rapidly grew 8-fold, and this growth preceded the availability of ranibizumab by more than a year. Moreover, in 2007, more than 50% of intravitreal injections in Ontario were performed by 3% of ophthalmologists. Conclusions: The development of vascular endothelial growth factor inhibitors has revolutionized the treatment of age-related macular degeneration. To our knowledge, this study is the first to quantify the dramatic uptake of these treatments at a population level. Our findings also suggest that off-label injection of bevacizumab was highly prevalent in Ontario. Serial intravitreal injections requiring direct physician administration and the concentration of injection procedures in the hands of a small number of ophthalmologists have the potential to affect services for other vision-threatening conditions.

Topical antibiotics and intravitreal injections

“…In the USA, the number of injections performed has increased exponentially in the past decade, and similar increases have been observed in Canada, the UK and Australia (Campbell et al 2010;Keenan et al 2012;CMS.gov, 2015;Medicare Australia 2016). In the USA, the number of injections performed has increased exponentially in the past decade, and similar increases have been observed in Canada, the UK and Australia (Campbell et al 2010;Keenan et al 2012;CMS.gov, 2015;Medicare Australia 2016).…”

“…Intravitreal injection is the most commonly performed invasive ophthalmic procedure. In the USA, the number of injections performed has increased exponentially in the past decade, and similar increases have been observed in Canada, the UK and Australia (Campbell et al 2010;Keenan et al 2012;CMS.gov, 2015;Medicare Australia 2016).…”

Topical antibiotics and intravitreal injections

“…In the USA, the number of injections performed has increased exponentially in the past decade, and similar increases have been observed in Canada, the UK and Australia (Campbell et al 2010;Keenan et al 2012;CMS.gov, 2015;Medicare Australia 2016). In the USA, the number of injections performed has increased exponentially in the past decade, and similar increases have been observed in Canada, the UK and Australia (Campbell et al 2010;Keenan et al 2012;CMS.gov, 2015;Medicare Australia 2016).…”

“…Intravitreal injection is the most commonly performed invasive ophthalmic procedure. In the USA, the number of injections performed has increased exponentially in the past decade, and similar increases have been observed in Canada, the UK and Australia (Campbell et al 2010;Keenan et al 2012;CMS.gov, 2015;Medicare Australia 2016).…”

Psychological and Cognitive Determinants of Vision Function in Age-Related Macular Degeneration

“…Although these treatments have expanded rapidly in the community in recent years, we know little of their impact outside of clinical trials. 44 The present data suggest that recognizing the role of patient coping strategies and cognition may inform outcome studies of anti-VEGF treatment and may have direct implications for the clinical care of patients. For researchers who use the NEI-VFQ in clinical trials, characterizing patient coping strategies and cognitive function may improve the precision of vision rating scales, reduce measurement error, and suggest new interventions to improve vision function and quality of life.…”

<p>The Top 100 Most-Cited Papers on Intravitreal Injections: A Bibliographic Perspective</p>

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Topical antibiotics and intravitreal injections

“…In the USA, the number of injections performed has increased exponentially in the past decade, and similar increases have been observed in Canada, the UK and Australia (Campbell et al 2010;Keenan et al 2012;CMS.gov, 2015;Medicare Australia 2016). In the USA, the number of injections performed has increased exponentially in the past decade, and similar increases have been observed in Canada, the UK and Australia (Campbell et al 2010;Keenan et al 2012;CMS.gov, 2015;Medicare Australia 2016).…”

“…Intravitreal injection is the most commonly performed invasive ophthalmic procedure. In the USA, the number of injections performed has increased exponentially in the past decade, and similar increases have been observed in Canada, the UK and Australia (Campbell et al 2010;Keenan et al 2012;CMS.gov, 2015;Medicare Australia 2016).…”

Psychological and Cognitive Determinants of Vision Function in Age-Related Macular Degeneration

“…Although these treatments have expanded rapidly in the community in recent years, we know little of their impact outside of clinical trials. 44 The present data suggest that recognizing the role of patient coping strategies and cognition may inform outcome studies of anti-VEGF treatment and may have direct implications for the clinical care of patients. For researchers who use the NEI-VFQ in clinical trials, characterizing patient coping strategies and cognitive function may improve the precision of vision rating scales, reduce measurement error, and suggest new interventions to improve vision function and quality of life.…”

<p>The Top 100 Most-Cited Papers on Intravitreal Injections: A Bibliographic Perspective</p>

“……”

Topical antibiotics and intravitreal injections

“…In the USA, the number of injections performed has increased exponentially in the past decade, and similar increases have been observed in Canada, the UK and Australia (Campbell et al 2010;Keenan et al 2012;CMS.gov, 2015;Medicare Australia 2016). In the USA, the number of injections performed has increased exponentially in the past decade, and similar increases have been observed in Canada, the UK and Australia (Campbell et al 2010;Keenan et al 2012;CMS.gov, 2015;Medicare Australia 2016).…”

“…Intravitreal injection is the most commonly performed invasive ophthalmic procedure. In the USA, the number of injections performed has increased exponentially in the past decade, and similar increases have been observed in Canada, the UK and Australia (Campbell et al 2010;Keenan et al 2012;CMS.gov, 2015;Medicare Australia 2016).…”

Psychological and Cognitive Determinants of Vision Function in Age-Related Macular Degeneration

“…Although these treatments have expanded rapidly in the community in recent years, we know little of their impact outside of clinical trials. 44 The present data suggest that recognizing the role of patient coping strategies and cognition may inform outcome studies of anti-VEGF treatment and may have direct implications for the clinical care of patients. For researchers who use the NEI-VFQ in clinical trials, characterizing patient coping strategies and cognitive function may improve the precision of vision rating scales, reduce measurement error, and suggest new interventions to improve vision function and quality of life.…”

<p>The Top 100 Most-Cited Papers on Intravitreal Injections: A Bibliographic Perspective</p>

“……”