Summary: imaging for diagnosis and treatment monitoring

Diagnosis and retreatment decisions in nAMD rely on retinal imaging, principally optical coherence tomography (OCT), with fluorescein angiography used mainly at diagnosis. A 2025 U.S. model priced an initial visit with office visit, OCT, and fluorescein angiography at $534.15 and each subsequent office visit with OCT at $184.58. In U.S. electronic health records, eyes underwent a mean of 7.2 OCT and 5.3 fluorescein angiography examinations in the first 12 months of treatment, and in commercial claims 88.1% of participants had at least one OCT visit per year (mean 4.5 visits). Among Medicare retina specialists, OCT increased from 61.5% of imaging in 2012 to 70.5% in 2016 while fluorescein angiography fell from 20.9% to 15.1%. OCT-guided as-needed and treat-and-extend dosing was estimated to have saved the U.S. government $9.0 billion and patients $2.2 billion from 2008 to 2015, net of about $0.8 billion in OCT imaging costs. In UK economic evaluations, SD-OCT monitoring of the fellow eye had lower lifetime costs than other monitoring tests, and strategies using OCT alone for diagnosis or monitoring were unlikely to be cost-effective.

Cost of monitoring visits with OCT and fluorescein angiography: U.S. model inputs (2025)

“The direct medical monitoring costs (2025, in USD) [29, 30] included office visits, fluorescein angiography, and optical coherence tomography (OCT) (Table S1 in the electronic supplementary material).” (opens the source at this quote in a new tab)
“Monitoring cost for initial visit in year 1 = (initial office visit + OCT + fluorescein angiography) = 534.15 USD.” (opens the source at this quote in a new tab)
“Direct medical monitoring costs in year 2 and thereafter (year ≥ 2) were equal to the adjusted number of injections (taking discontinuation and mortality into account) in year ≥ 2 multiplied by 184.58 USD (i.e., subsequent office visit + OCT).” (opens the source at this quote in a new tab)

OCT and fluorescein angiography use among Medicare retina specialists, 2012 to 2016

“National relative utilization of OCT increased from 61.5% in 2012 to 70.5% in 2016 (P < .001), while IVFA fell from 20.9% to 15.1% over the same interval (P < .001).” (opens the source at this quote in a new tab)
“Fundus photography decreased from 14.6% in 2012 to 11.7% in 2016 (P < .001).” (opens the source at this quote in a new tab)

Retinal imaging volume and anti-VEGF injection volume in Medicare, 2013 to 2021

“For anti-VEGF injections, a positive association in annual volume was observed with ocular coherence tomography ( P < 0.001, R 2 = 0.84), whereas negative associations were observed with FA ( P < 0.001, R 2 = 0.89) and FA + indocyanine-green angiography ( P < 0.001, R 2 = 0.90).” (opens the source at this quote in a new tab)
“Ocular coherence tomography continues to rise as a percentage of all retinal imaging ordered, whereas FA has declined.” (opens the source at this quote in a new tab)

Medicare and patient savings from OCT-guided anti-VEGF therapy, 2008 to 2015

“From 2008 – 2015, the United States government and nvAMD patients have accrued an estimated savings of $9.0 billion and $2.2 billion, respectively, from the use of OCT to guide personalized anti-VEGF treatment.” (opens the source at this quote in a new tab)

“Using the meta-analysis and survey data, we calculated the cost of using OCT imaging to guide anti-VEGF treatment decisions from 2008– 2015 was $0.8 billion.” (opens the source at this quote in a new tab)
“Anti-VEGF drugs, their injection and OCT imaging are covered under Medicare Part B, which requires beneficiaries to copay 20% of the Medicare-approved amount in the absence of supplementary Medigap insurance.” (opens the source at this quote in a new tab)

Imaging studies per beneficiary in Medicare, 1994 to 2006 cohorts

“There were significant increases in the mean yearly number of visits (2.1 vs. 3.5, p<0.0001), OCTs (0 vs. 2.1, <0.0001), and anti-VEGF injections (0 vs. 2.0, p<0.0001) between 1994 and 2006.” (opens the source at this quote in a new tab)
“From 1994 to 2006, payments for fluorescein angiography remained essentially stable, while those for OCT increased significantly.” (opens the source at this quote in a new tab)

OCT-related visits by disease activity: U.S. commercial claims

OCT test-related visits, prevalent cohort	All patients	Active CNV	Inactive CNV	Inactive scar
Patients with at least 1 visit, n (%)	“5,350 (88.1)”	“3,384 (92.6)”	“893 (85.4)”	“253 (70.7)”
Number of unique visits, mean (SD)	“4.5 (3.5)”	“5.4 (3.6)”	“2.9 (2.6)”	“1.6 (1.9)”

Monitoring frequency in routine practice: U.S. claims, 2006 to 2011

“In the 2008-2010 cohorts (n = 10 259), mean annual number of injections remained low (bevacizumab: 4.6, 5.1, and 5.5; ranibizumab: 6.1, 6.6, and 6.9), as did mean numbers of ophthalmologist visits (bevacizumab only) and OCT examinations (both agents), but there was no such trend in FA examinations.” (opens the source at this quote in a new tab)

“In the 2010 cohort, among bevacizumab- and ranibizumab-treated patients, respectively, less than 23% and less than 40% had at least 10 ophthalmologist visits, and less than 4% and less than 21% had at least 10 optical coherence tomography scans.” (opens the source at this quote in a new tab)

OCT examinations per year and vision-related quality of life: Germany (ALBATROS)

“1478 patients (74.5 ± 10.9 years, 54.9% female) were included in the analysis.” (opens the source at this quote in a new tab)
“8.8 ± 2.6 OCT examinations and 6.1 ± 3.2 intravitreal injections were performed within 12 months.” (opens the source at this quote in a new tab)
“After twelve months, an increase in visual acuity and visual functional scale was observed for nAMD, DME, and BRVO, while in DME only, there was an association between number of OCT examinations and VRQoL.” (opens the source at this quote in a new tab)

Cost-effectiveness of OCT for diagnosis and monitoring: UK Health Technology Assessment

“For monitoring, the pooled sensitivity and specificity (95% CI) was 85% (72% to 93%) and 48% (30% to 67%) respectively.” (opens the source at this quote in a new tab)
“The FFA for diagnosis and nurse-technician-led monitoring strategy had the lowest cost (£ 39,769; QALYs 10.473) and dominated all others except FFA for diagnosis and ophthalmologist-led monitoring (£ 44,649; QALYs 10.575; incremental cost-effectiveness ratio £ 47,768).” (opens the source at this quote in a new tab)
“Strategies involving OCT alone for diagnosis and/or monitoring were unlikely to be cost-effective.” (opens the source at this quote in a new tab)

Monitoring tests for nAMD in the fellow eye: EDNA economic evaluation (UK)

“SD-OCT generated more QALYs (SD-OCT, 5.830; fundus assessment, 5.787; Amsler grid, 5.736, patient's subjective assessment, 5.630; and visual acuity, 5.600) and lower health and social care costs (SD-OCT, £19 406; fundus assessment, £19 649; Amsler grid, £19 751; patient's subjective assessment, £20 198 and visual acuity, £20 444) per patient compared with other individual monitoring tests.” (opens the source at this quote in a new tab)
“Probabilistic sensitivity analysis indicated a high probability (97%-99%) of SD-OCT being the preferred test across a range of cost-effectiveness thresholds (£13 000-£30 000) applied in the UK NHS.” (opens the source at this quote in a new tab)

“The diagnostic accuracy [sensitivity (%) (95% confidence interval); specificity (%) (95% confidence interval)] was as follows: optical coherence tomography 91.7 (85.2 to 95.6); 87.8 (83.8 to 90.9)]” (opens the source at this quote in a new tab)

Community optometrist versus hospital monitoring of quiescent nAMD: cost per assessment (UK)

“The mean cost per assessment, including the subsequent care pathway, was £411 for optometrists and £397 for ophthalmologists: a cost difference of £13 (95% CI -£18 to £45).” (opens the source at this quote in a new tab)

AXPAXLI (axitinib intravitreal implant)

Economic impact of diagnostic testing