Dataset Information

Retrospective Analysis of the Pharmaco-Utilization of VEGF Inhibitors and Health Care Costs among Patients with Wet Age-Related Macular Degeneration and Other Ocular Diseases in Italy.

ABSTRACT: This Italian retrospective study aimed to analyze the pharmaco-utilization of anti-VEGF drugs and health care costs among patients with wet age-related macular degeneration (wAMD) or other ocular diseases. A retrospective analysis was performed on administrative databases of Italian entities covering approximately six million individuals. Across January 2010-December 2017, patients aged ≥50 years with a prescription of intravitreal anti-VEGFs were included as "wAMD" patients [by wAMD hospitalization or intravitreal injections] or as "other ocular diseases" patients [by hospitalization for other ocular disorders or intravitreal injections, with concomitant diabetes diagnosis or dexamethasone treatment]. The date of first matching of inclusion criteria was index-date. wAMD-cohort. Overall, 3879 patients were included; at index-date, 82.2% were treated with Ranibizumab, 15.8% with Aflibercept, and 2% with Pegaptanib. During the follow-up, the mean/annual anti-VEGF prescription [3.6 (first-year)-0.8 (third-year)] and the total expenditure [5799.84 € (first-year)-3212.84 € (third-year)] decreased. Other ocular diseases-cohort. Overall, 2646 patients were enclosed; 85.9% were treated with Ranibizumab, 13.5% with Aflibercept, and 0.6% with Pegaptanib. During the follow-up, the mean/annual anti-VEGF prescription [3.3 (first-year)-0.5 (third-year)] and the total cost [7196.83 € (first-year)-5162.68 € (third-year)] decreased. This observational study highlighted a decline in anti-VEGF prescriptions over time in both cohorts, suggesting a trend of under-treatment that could worsen the patients' clinical outcomes and increase health care resource consumption.

SUBMITTER: Perrone V

PROVIDER: S-EPMC8909764 | biostudies-literature | 2022 Feb

REPOSITORIES: biostudies-literature

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Retrospective Analysis of the Pharmaco-Utilization of VEGF Inhibitors and Health Care Costs among Patients with Wet Age-Related Macular Degeneration and Other Ocular Diseases in Italy.

Perrone Valentina V Dovizio Melania M Veronesi Chiara C Citraro Rita R De Francesco Adele A Dell'Orco Stefania S Di Manno Gianluca G Paciello Arrigo A Resta Anna Maria AM Quarta Fabrizio F Ferrante Nicola N Ritrovato Daniela D Degli Esposti Luca L

International journal of environmental research and public health 20220223 5

This Italian retrospective study aimed to analyze the pharmaco-utilization of anti-VEGF drugs and health care costs among patients with wet age-related macular degeneration (wAMD) or other ocular diseases. A retrospective analysis was performed on administrative databases of Italian entities covering approximately six million individuals. Across January 2010-December 2017, patients aged ≥50 years with a prescription of intravitreal anti-VEGFs were included as "wAMD" patients [by wAMD hospitaliza ...[more]

PMID: 35270241

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Project description:PurposeTo explore the alterations in metabolites of wet age-related macular degeneration (wAMD) by conducting metabolomics in aqueous humor from patients with wAMD and to assess the potential effects of anti-vascular endothelial growth factor (anti-VEGF) on these metabolites.MethodsMetabolomic analysis was performed on the aqueous humor of 30 patients with wAMD receiving anti-VEGF treatments and 20 controls, via ultra-high performance liquid chromatography tandem mass spectrometry. The aqueous humor samples collected from untreated patients with wAMD were classified as the pre-wAMD group. Accordingly, the samples collected from patients with wAMD receiving one anti-VEGF treatment were designated as the post-wAMD group. Individuals were further classified into responders and nonresponders according to their reaction to the treatment. Principal component analysis, hierarchical cluster analysis, and the Kyoto Encyclopedia of Genes and Genomes annotation and enrichment analysis, were subsequently performed. Machine learning and receiver operating characteristic curve analyses were used to further analyze potential vital metabolites.ResultsAmong the 1001 metabolites verified in the aqueous humor, 306 compounds separated patients with pre-wAMD from the control group, whereas 68 metabolites differentiated patients with post-wAMD and patients with pre-wAMD. Enrichment in metabolic pathways was noted in ABC transporters, thiamine metabolism, glycerophospholipid metabolism, mammalian target of rapamycin signaling pathway and tyrosine metabolism, and so on. Machine learning and receiver operating characteristic curves analysis suggested that δ-valerolactam could not only distinguish between patients with wAMD and the control group, but also differentiate between patients with post-wAMD and patients with pre-wAMD. Changes in acylcarnitine were observed in anti-VEGF responders with wAMD.ConclusionsThere were noticeable alterations in the aqueous humor of patients with wAMD involving many metabolites that are associated with ABC transporters, glycerophospholipid metabolism, and the mammalian target of rapamycin signaling pathway. It is possible that δ-valerolactam can be applied as a biomarker in wAMD.

Project description:BackgroundTo evaluate the impact of reimbursement criteria change on the utilization pattern of anti-vascular endothelial growth factor (anti-VEGF) among patients with wet age-related macular degeneration (wAMD) and diabetic macular edema (DME) separately in Taiwan.MethodsAn interrupted time series analysis (ITSA) was performed using Taiwan's National Health Insurance (NHI) database, and patients with wAMD or DME diagnosis at the first injection of anti-VEGF agents was identified from 2011 to 2019. The outcome of interest was treatment gaps between injections of anti-VEGF. This outcome was retrieved quarterly, and the study period was divided into three phases in wAMD (two criteria changed in August 2014 [intervention] and December 2016 [intervention]) and two phases in DME (three consecutive criteria changed in 2016 [intervention]). Segmented regression models adjusted for autocorrelation were used to estimate the change in level and the change in slope of the treatment gaps between each anti-VEGF injection.ResultsThe treatment gaps between each anti-VEGF injection decreased from 2011 to 2019. The cancellation of the annual three needles limitation was associated with significantly shortened treatment gaps between the third and fourth needles (wAMD change in level: -228 days [95% CI -282, -173], DME change in level: -110 days [95% CI -141, -79]). The treatment gap between the fifth and sixth needles revealed a similar pattern but without significant change in DME patients. Other treatment gaps revealed considerable change in slopes in accordance with criteria changes.ConclusionThis is the first nationwide study using ITSA to demonstrate the impact of reimbursement policy on treatment gaps between each anti-VEGF injection. After canceling the annual limitation, we found that the treatment gaps significantly decreased among wAMD and DME patients. The shortened treatment gaps might further link to better visual outcomes according to previous studies. The different impacts from criteria changes can assist future policy shaping. Future studies were warranted to explore whether such changes are associated with the benefits of visual effects.

Dataset Information

Retrospective Analysis of the Pharmaco-Utilization of VEGF Inhibitors and Health Care Costs among Patients with Wet Age-Related Macular Degeneration and Other Ocular Diseases in Italy.

Publications

Retrospective Analysis of the Pharmaco-Utilization of VEGF Inhibitors and Health Care Costs among Patients with Wet Age-Related Macular Degeneration and Other Ocular Diseases in Italy.

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