Tracing the natural course of visual acuity and quality of life in neovascular age-related macular degeneration: a systematic review and quality of life study

Elshout, Mari; Webers, Carroll A.B.; Reis, Margriet I. van der; Jong‐Hesse, Yvonne de; Schouten, Jan S.A.G.

doi:10.1186/s12886-017-0514-3

Cited by 27 publications

(19 citation statements)

References 38 publications

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“…; Elshout et al. ). Therefore, we believe that the time horizon of the CEA ideally should be 4 years (with little to no extrapolation of disease progression needed) or more (with proper extrapolation).…”

Section: Methodsmentioning

confidence: 98%

A systematic review on the quality, validity and usefulness of current cost‐effectiveness studies for treatments of neovascular age‐related macular degeneration

Elshout

Webers

Reis

et al. 2018

Acta Ophthalmologica

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Two of the CEAs of sufficient quality and validity show that bevacizumab PRN is the most cost-effective treatment. Comparing ranibizumab and aflibercept, either treatment can be more cost-effective depending on the assumptions used for drug prices and treatment frequencies. The majority of the published CEAs are of insufficient quality and validity. They wrongly inform decision-makers at the cost of opportunities for ophthalmologists to treat patients. As such, they may negatively influence overall patient outcomes and societal costs. For future ophthalmic treatments, CEAs need to be improved and only published when they are of sufficient quality and validity.

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Section: Methodsmentioning

confidence: 98%

A systematic review on the quality, validity and usefulness of current cost‐effectiveness studies for treatments of neovascular age‐related macular degeneration

Elshout

Webers

Reis

et al. 2018

Acta Ophthalmologica

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“…For example, a recent study of a large US real-life cohort revealed stable mean VA with +/− 0 letters at one year 12 . This is considerably better than the natural history of untreated nAMD but far from the VA gains found in randomized clinical trials (RCTs) 13 . The main difference between real-life data and RCTs is that RCTs represent a highly selected cohort of patients.…”

Section: Discussionmentioning

confidence: 83%

Anti-VEGF injection frequency correlates with visual acuity outcomes in pro re nata neovascular AMD treatment

Wecker

Grundel

Reichl

et al. 2019

Sci Rep

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Clinical trials report substantial gains in visual acuity (VA) for eyes treated with intravitreal anti-VEGF for neovascular AMD (nAMD). In clinical reality, VA outcomes are more variable. Here we investigate pro-re nata treatment frequencies and VA in a real-life cohort of 1382 eyes (1048 patients). Patients with nAMD and one year complete follow-up treated with pro-re nata anti-VEGF between 2009 and 2016 were included. Injection frequency and VA was analyzed clustered by year of first treatment. Baseline parameters were compared between years. Median injection frequency in the first year was 5 with an IQR (interquartile range) of 5 for patients treated in 2009 and 8 with an IQR of 3 for patients treated from 2012 onwards. Median VA outcomes at one year were −5 to ±0 letters for patients treated between 2009 and 2013 and ±0 to +2 letters for patients treated from 2013 onwards. This cohort comprises all severities and subtypes of nAMD. 39% of patients had baseline VA outside the range for the MARINA or ANCHOR clinical trials. Higher treatment frequency was associated with improved VA in our real-life nAMD cohort. With adequate injection frequency, almost 90% of eyes had stable or improved VA over one year. Median VA gains, however, were lower compared to clinical trials. This may be due to a wider range of baseline characteristics in real-life cohorts.

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“…In comparing PDT and anti-VEGF, we needed to adjust for CNV lesion type, since PDT was not indicated for all lesions, and we observed a difference in lesion types between PDT and anti-VEGF groups (Table 1). Furthermore, lesion type determines the prognosis [37][38][39]. We found that, after adjusting for lesion type, occult or classic CNV, there was no effect of PDT.…”

Section: Addressing Confoundingmentioning

confidence: 99%

A systematic approach to evaluate practice-based process- and outcome data applied to the treatment of neovascular age-related macular degeneration

et al. 2020

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Background: Following the principles of value-based health care, outcomes and processes of daily-practice eye care need to be systematically evaluated. We illustrate an approach that can be used to support data-driven quality improvements. We used patient data regarding the treatment of neovascular age-related macular degeneration (nAMD). Methods: In a cohort study, we reviewed medical records of patients with nAMD confirmed on fluorescein angiography (FA). Patients were treated with intravitreal injections with bevacizumab; ranibizumab; or photodynamic therapy (PDT). Visual acuity (VA), ophthalmic exam results and treatments were recorded. VA was compared between treatments by linear mixed model. Diagnosis was re-evaluated on the original FAs. Outcome analysis was performed by 1) selecting VA as the relevant outcome parameter; 2) Preventing selection by comparing treatments with historical untreated cohort and cohorts from the literature, 3) correcting for confounding due to lesion type, and 4) identifying relevant process variables that affect the outcome. These were severity of disease at presentation, and doctor-and patient dependent process variables. Results: In total, 473 eyes were included. At 12 months, change in VA was 0.54, 0.48, 0.09, and 0.07 LogMAR in the notreatment, photodynamic therapy (PDT), bevacizumab, and ranibizumab groups, respectively. Lesion type on FA differed between groups. Diagnosis of nAMD could not be confirmed in 104 patients. Patient delay, inaccurate diagnosis and treatment intervals may have impacted outcomes. Conclusions: The effect of PDT was small to absent. Anti-VEGFs were effective and appeared as effective as in RCTs. Correct selection of a comparator cohort and addressing confounding, including confounding by indication and effect modification, are needed to achieve valid results and interpretation. Patient delay, diagnosis accuracy, indication for and application of treatment can potentially be improved to improve treatment outcomes. In a value-based care perspective, systematic evaluation of diagnostic accuracy, treatment indication, protocols, and outcomes of new interventions is needed at an early stage to improve outcomes.

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Tracing the natural course of visual acuity and quality of life in neovascular age-related macular degeneration: a systematic review and quality of life study

Cited by 27 publications

References 38 publications

A systematic review on the quality, validity and usefulness of current cost‐effectiveness studies for treatments of neovascular age‐related macular degeneration

A systematic review on the quality, validity and usefulness of current cost‐effectiveness studies for treatments of neovascular age‐related macular degeneration

Anti-VEGF injection frequency correlates with visual acuity outcomes in pro re nata neovascular AMD treatment

A systematic approach to evaluate practice-based process- and outcome data applied to the treatment of neovascular age-related macular degeneration

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