Product information and disease description Place of product in therapy Disease description Burden of Neovascular age-related macular degeneration

Economic burden and healthcare resource utilization

18 evidence topics · 10 sources

Direct healthcare costs: commercially insured United States population

“Mean (SD) annual total all-cause cost for the prevalent cohort was $24,520 ($43,950) with outpatient costs as the largest cost component” (opens the source at this quote in a new tab)
“The nAMD-related outpatient costs represented 28% of total costs and 44% of total outpatient costs, respectively, and were driven primarily by anti-VEGF injection-related costs” (opens the source at this quote in a new tab)
“Annual all-cause cost was lower for the incident cohort compared to the prevalent cohort (mean [SD] = $18,943 [$29,236] vs mean [SD] = $24,520 [$43,950], respectively).” (opens the source at this quote in a new tab)
“Patients with active choroidal neovascularization (CNV) incurred at least $7,000 higher all-cause annual costs than patients with inactive CNV or inactive scar, largely driven by higher outpatient/anti-vascular endothelial growth factor (anti-VEGF) costs.” (opens the source at this quote in a new tab)

Annual visit and injection burden: commercially insured United States population

“Mean (SD) annual nAMD-related outpatient burden was 6.6 (4.8) visits overall; patients with active CNV had the highest utilization compared with patients with inactive CNV or inactive scar (P < 0.0001). Overall mean (SD) annual anti-VEGF–related outpatient visit burden was 3.9 (4.2) visits, with the highest utilization seen in active CNV group compared with inactive CNV and inactive scar groups (P < 0.0001).” (opens the source at this quote in a new tab)

Medicare Part B anti-VEGF injection volume and reimbursement, 2014 to 2023

“From 2014 to 2023, a total of 36 398 293 intravitreal anti-VEGF injections were administered to Medicare beneficiaries. Aflibercept use increased significantly (618 796 injections in 2014 vs. 1 713 729 in 2023; τ = 0.91; P < 0.001).” (opens the source at this quote in a new tab)
“Standardized Medicare reimbursement per injection declined significantly for ranibizumab ($1234.35-$724.74; τ = -1.00; P < 0.001) and aflibercept ($1527.37-$1379.54; τ = -0.82; P = .001), remained stable for brolucizumab, and increased for bevacizumab ($46.76-$300.73; τ = 0.69; P < 0.01).” (opens the source at this quote in a new tab)

Medicare Part B anti-VEGF spending per beneficiary

“During this 5-year period, associated Medicare drug costs averaged $1.3 billion annually. The number of Medicare Part B claims for aflibercept increased from 518 836 in 2013 to 866 749 in 2015. Annual Medicare drug expenditure for aflibercept was $1.4 billion on average. On average, Medicare spent $9719 and $9934 annually on each beneficiary receiving ranibizumab and aflibercept injections, respectively.” (opens the source at this quote in a new tab)
“Ranibizumab and aflibercept costs account for 12% of the Medicare Part B budget annually.” (opens the source at this quote in a new tab)

“Age-related macular degeneration (ARMD) therapies aflibercept and ranibizumab are among the highest-cost Medicare Part B drugs, even though off-label use of lower-cost bevacizumab is clinically noninferior.” (opens the source at this quote in a new tab)

AMD treatment costs per Medicare fee-for-service beneficiary, 2004 to 2018

“Annual costs among Medicare fee-for-service (FFS) beneficiaries increased from $261 per patient in 2004 to $1290 per patient in 2018.” (opens the source at this quote in a new tab)

Societal costs by visual acuity in the better-seeing eye

“The mean annual societal cost for the Control Cohort was $6,116 and for the Study Cohort averaged $39,910 (P < 0.001). Study Subcohort 1 costs averaged $20,339, while Subcohort 4 costs averaged $82,984.” (opens the source at this quote in a new tab)
“Total societal ophthalmic costs associated with neovascular age-related macular degeneration dramatically increase as vision in the better-seeing eye decreases.” (opens the source at this quote in a new tab)

Costs of vision loss and blindness in the United States

“We estimated an economic burden of VL of $134.2 billion: $98.7 billion in direct costs and $35.5 billion in indirect costs. The largest burden components were NH ($41.8 billion), other medical care services ($30.9 billion), and reduced labor force participation ($16.2 billion), all of which accounted for 66% of the total. Those with VL incurred $16 838 per year in incremental burden.” (opens the source at this quote in a new tab)
“Informal care was the largest burden component for people 0 to 18 years of age, reduced labor force participation was the largest burden component for people 19 to 64 years of age, and NH costs were the largest burden component for people 65 years of age or older.” (opens the source at this quote in a new tab)

Clinic time burden for staff and patients

“Patients accounted for 20% of the health care staff's time per week, with an average of 23 staff members. An average patient visit for neovascular AMD was 90 minutes (range: 13 minutes to >4 hours).” (opens the source at this quote in a new tab)

Estimated Medicare savings from bevacizumab use

“The use of bevacizumab from 2008 to 2015 resulted in an estimated savings of $17.3 billion, which corresponded to a $13.8 billion savings to Medicare and a $3.5 billion savings to patients.” (opens the source at this quote in a new tab)

Anti-VEGF agent use across United States payers, 2017 to 2023

“Patients with Medicare B or C were significantly more likely to receive aflibercept over bevacizumab.” (opens the source at this quote in a new tab)

Total Medicare expenditure on anti-VEGF therapy, 2014 to 2023

“From an economic perspective, total Medicare expenditures for anti-VEGF therapy rose from approximately $2.5 billion USD in 2014 to $3.7 billion USD in 2023, despite declining reimbursement per injection for aflibercept and ranibizumab.” (opens the source at this quote in a new tab)
“This increase was primarily driven by rising injection volumes and the introduction of newer branded agents (faricimab and brolucizumab).” (opens the source at this quote in a new tab)

Annual Medicare drug cost per treated beneficiary by agent, 2022

“Bevacizumab, despite its widespread use in cost-sensitive settings, contributed minimally to total Medicare expenditures because of its low average cost per dose ($241 USD annually per beneficiary treated for wet age-related macular degeneration in 2022), compared with $8219 USD for aflibercept and $6143 USD for ranibizumab.” (opens the source at this quote in a new tab)

Injection rates per 100,000 Medicare beneficiaries by agent, 2014 to 2023

“aflibercept increased from 1864/100 000 to 5997/100 000 beneficiaries (221% rise)” (opens the source at this quote in a new tab)
“Ranibizumab declined overall by 44%, decreasing from 2437/100 000 to 1359/100 000 between 2014 and 2023, with an interim peak of 2591/100 000 in 2019.” (opens the source at this quote in a new tab)
“Faricimab increased from 219/100 000 to 1947/100 000 between 2022 and 2023 (789% rise), whereas brolucizumab declined from 142 to 18 per 100 000 (87% decline).” (opens the source at this quote in a new tab)

State-level variation in anti-VEGF injection rates, 2023

“For aflibercept, Alaska recorded the highest injection rate at 68 241/100 000, whereas Hawaii had the lowest at 2602/100 000, resulting in a 26.2-fold difference.” (opens the source at this quote in a new tab)
“Faricimab utilization ranged from 207/100 000 in Vermont to 10 247/100 000 in Nebraska, a 49.4-fold difference.” (opens the source at this quote in a new tab)
“Because the MPUPD data set captures only FFS claims, states with higher MA enrollment have smaller captured FFS denominators, which may inflate calculated per-capita injection rates.” (opens the source at this quote in a new tab)

Staff time devoted to neovascular age-related macular degeneration care in retina practices

Staff type	Average number involved in neovascular AMD care (range)	Average share of a 40-hour work week spent in neovascular AMD care (range)	Average time per staff member per week	Average hours per week, all staff members
Receptionist	“5 (1–18 people)”	“20% (1%–75%)”	“8 hours”	“28 hours”
Office manager	“2 (0–10 people)”	“13% (0%–75%)”	“4 hours”	“10 hours”
Billing manager	“2 (0–6 people)”	“22% (0%–80%)”	“8 hours”	“18 hours”
Technician	“8 (1–50 people)”	“34% (3%–90%)”	“14 hours”	“112 hours”
Physicians other than retina specialists	“2 (0–18 people)”	“15% (0%–65%)”	“6 hours”	“12 hours”
Other staff members	“4 (1–12 people)”	“25% (5%–70%)”	“10 hours”	“40 hours”

Practice total	Quoted value
Staff members involved in neovascular AMD care	“23 people”
Office time per week across all staff members	“225 hours”

“The present study demonstrated that practices are highly invested in the management of patients with neovascular AMD, with an average retina practice consisting of 23 staff members involved in the disease management for every 1 treating retina specialist.” (opens the source at this quote in a new tab)
“In total, the management of patients with neovascular AMD accounts for one-fifth of the staff’s working week, and this estimate may likely underestimate the true workflow based on less structured communications with retina specialists.” (opens the source at this quote in a new tab)
“The management of patients with neovascular AMD accounted for an average of 20% of the staff’s time per work week: most technicians (68%) spent more than 20% of their time, one-quarter of office managers spent more than 10% of their time, and more than one-third (37%) of billing managers spent more than 20% of their time managing patients with neovascular AMD” (opens the source at this quote in a new tab)

Retina specialist views on monitoring and injection frequency as burdens on staff, materials, and office space

“When asked about the impact of activities for monitoring and injection administration on staff time, the majority of the surveyed retina specialists (62%, 35 of 57) felt that frequency of patient monitoring placed a significant burden on staff time. A large percentage of retina specialists (58%, 33 of 57) felt that billing and filing for reimbursement was also a significant burden on staff resources.” (opens the source at this quote in a new tab)
“In addition, 42% (24 of 57) of retina specialists considered monitoring frequency to be very impactful on material resources such as drugs and other supplies.” (opens the source at this quote in a new tab)
“Forty-nine percent (28 of 57) of retina specialists reported that the frequency of injections was an impactful burden on office space, including waiting rooms and examination rooms. Over one-third of physicians (35%, 20 of 57) considered frequency of patient monitoring to be an important motivator in choosing a treatment to prescribe. Two-thirds of physicians (38 of 57) stated they would find it very desirable to reduce office visits.” (opens the source at this quote in a new tab)

Visit preparation time and post-injection recovery time

“Although these preparatory steps were typically performed concurrently, the average total staff time spent on all preparation steps was 43 minutes.” (opens the source at this quote in a new tab)
“More than one-third (36%, 27 of 75) of patients reported that their most recent visit took 90 minutes or more, and 79% (59 of 75) reported spending at least 3 hours recovering following injections.” (opens the source at this quote in a new tab)

Practice setting and monthly injection volume of the surveyed retina specialists

“There were 57 retina specialists involved in the survey, 68% (39 of 57) were in a group practice, 14% (8 of 57) practiced in an academic setting, and 18% (10 of 57) were solo practitioners.” (opens the source at this quote in a new tab)
“The average total number of patients treated per month in these 3 settings was 556, and the average number of neovascular AMD patients treated per month was 201.” (opens the source at this quote in a new tab)
“The quantitative research section of this study was conducted between July and November 2011; additional sampling of respondents from Midwest and Great Plains states was carried out from June through August 2012, as these regions were underrepresented in the original sample.” (opens the source at this quote in a new tab)