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

Economic impact of Neovascular age-related macular degeneration on families

14 evidence topics · 12 sources

Summary: caregiver time, lost work, and transport

Most people receiving anti-VEGF therapy for nAMD rely on an informal caregiver to attend appointments. In a nine-country survey, 82.1% of 910 participants received caregiver support and 56.7% were usually taken to appointments by a caregiver. In a U.S. time-and-motion study, participants reported that caregivers took time away from work (22%) and personal activities (28%) to provide transport. In a 2024 multinational survey including U.S. caregivers, 70.5% of working caregivers (n = 44) reported absenteeism due to treatment or monitoring appointments. In a UK survey of 250 caregivers, 24.8% took time off work and 70% spent at least half a day on each clinic visit. An Australian study estimated caregiver time accompanying the patient at 6.2 hours per month and an annual caregiver cost of AU$5,333.58. A U.S. economic model applied an indirect cost of $289.98 per injection for patient and caregiver time and travel. In a 2006 U.S. survey, annual caregiving costs ranged from $225 to $47,086 depending on visual acuity.

Caregiver time away from work for transport: U.S. time-and-motion study

“A survey was administered to 75 neovascular AMD patients aged ≥50 years who received ≥1 anti-VEGF injection in the past 6 months.” (opens the source at this quote in a new tab)
“Telephone interviews were conducted with 13 neovascular AMD patient caregivers.” (opens the source at this quote in a new tab)
“Patients stated that caregivers took time away from work (22%) and personal activities (28%) to provide transportation to appointments.” (opens the source at this quote in a new tab)

Caregiving use and cost by visual acuity: U.S. survey

“Of 803 respondents, 56% were male, and the mean age was 73 years.” (opens the source at this quote in a new tab)
“Use of paid and unpaid help significantly increased as visual acuity decreased.” (opens the source at this quote in a new tab)
“Using a national average for caregiver time, annual costs for caregiving ranged from 225 to 47,086 US dollar depending on visual acuity.” (opens the source at this quote in a new tab)

Caregiver time and work absenteeism: multinational caregiver survey including the United States

“Caregivers for patients with DME (n = 30) and nAMD (n = 95) completed surveys.” (opens the source at this quote in a new tab)
“Mean ± SD length of time as a caregiver was 9.1 ± 10.0 years.” (opens the source at this quote in a new tab)
“Caregivers estimated they provided support for 4.2 ± 2.9 days/week and 6.0 ± 7.1 h/day on average.” (opens the source at this quote in a new tab)
“Nearly half of caregivers (45.6%) reported some impairment in daily activities, and more than two-thirds (70.5%) of working caregivers (n = 44) reported work absenteeism due to anti-VEGF treatment/monitoring appointments.” (opens the source at this quote in a new tab)

Caregiver burden, time off work, and loss of income: UK

“This is a cross-sectional questionnaire survey of 250 matched patient caregiver dyads across three large ophthalmic treatment centres in United Kingdom.” (opens the source at this quote in a new tab)
“The mean CRA score was 3.2±0.5, similar to the score reported by caregivers for atrial fibrillation who require regular hospital appointments for monitoring their thromboprophylaxis.” (opens the source at this quote in a new tab)
“Ranibizumab therapy for nAMD is associated with significant caregiver burden. Both disease impact and treatment frequency contributed to the overall burden.” (opens the source at this quote in a new tab)

“The most common eye-related care activity undertaken was accompanying patients for their eye clinic appointments, with 70.8% carers having attended ≥10 appointments over the last year.” (opens the source at this quote in a new tab)
“On an average, the caregivers reported that 70% spent at least half a day and 43.6% spent most of the day assisting their patient with their clinic visit every 4–6 weeks.” (opens the source at this quote in a new tab)
“24.8% of caregivers required time off work to support patients with their eye treatment, and 10% of them reported that this led to a loss of income.” (opens the source at this quote in a new tab)

Caregiver roles and attendance at appointments: nine-country patient and caregiver survey

“A total of 910 patients with wAMD and 890 caregivers completed the questionnaire.” (opens the source at this quote in a new tab)
“The majority of patients (82.1%; n=747/910) received support from a caregiver.” (opens the source at this quote in a new tab)
“Only 6.5% (n=58/890) were professional (paid) caregivers.” (opens the source at this quote in a new tab)
“Most caregivers always attended appointments (60.1%; n=535/890) and were involved in discussions about the treatment plan (83.3%; n=555/666; Table 3).” (opens the source at this quote in a new tab)
“Most patients (56.7%; n=516/910) were usually taken to the appointment by a caregiver; however, 20.4% (n=186/910) went by public transport, 12.4% (n=113/910) drove themselves, 8.1% (n=74/910) used a taxi, and 2.3% (n=21/910) were taken by an ambulance.” (opens the source at this quote in a new tab)

Caregiver time and costs: Australia (Australian dollars)

“The caregivers reported the time they spent accompanying the patient to their medical appointments specifically for intravitreal injections took an average of 6.2±1.1 hours per month, which equates to a loss of $262.45±$46.60 in income based on the national average hourly wage.” (opens the source at this quote in a new tab)
“Several caregivers indicated indirect costs due to lost productivity in the workplace, having to take considerable time off work in order to bring the patient in for monthly appointments and injections.” (opens the source at this quote in a new tab)

Cost or time item	Mean ± SD
Number of visits per year	“10.4±0.8”
Travel and parking costs, AU$	“64.80±79.70”
Travel time per visit, hours	“2.4±1.6”
Caregiver time spent accompanying patient to appointment, hours	“6.2±1.1”
Hours per week needing assistance	“4.3±3.2”
Annual mean cost of caregivers, AU$	“5,333.58±2,184.20”

Caregiver time off work per treatment visit: Sweden

“Caregivers spent on average 2.6 h (2.5-2.8: 95% CI) per visit, and 19% needed to take time off work.” (opens the source at this quote in a new tab)
“The majority (91%) of patients did not experience any transportation problems associated with treatment.” (opens the source at this quote in a new tab)

Indirect cost per injection for patients and caregivers: U.S. economic model

“Indirect costs per injection for patients and carers were calculated using multiple parameters, including caregiver time taken for an injection appointment [31], the average US wage per working hour [32], reduction in hourly wage for nonworking people’s time [33], hours of lost productivity for a patient due to the injection and appointment [34], percentage of carers’ time taken from activities [34], percentage of patients who require a caregiver [34], the average distance, in miles, traveled to get to an appointment [34, 35], and cost per mile traveled [36], for an indirect total cost of 289.98 USD per injection for patient and carer” (opens the source at this quote in a new tab)
“Indirect costs represent a relatively small proportion of the overall costs compared with the drug costs.” (opens the source at this quote in a new tab)

Caregiver share of productivity losses: late-stage AMD in the United States

“Parameters included patient job loss, patient job reduction, caregiver job reduction due to caregiving responsibilities, caregiver job reduction due to providing transport to eye health care appointments, and caregiver loss of leisure time due to providing transport.” (opens the source at this quote in a new tab)
“In nAMD, 99% of the total cost attributed to the loss of productivity was due to the impact on patients, with caregivers contributing to the remaining 1% of the cost.” (opens the source at this quote in a new tab)

Hospital appointments as a driver of caregiver burden: systematic review

“The need to attend hospital appointments was identified in various studies as an important contributor to caregiver burden (Gohil et al., 2015; Varano et al., 2015; Spooner et al., 2018).” (opens the source at this quote in a new tab)
“Approximately two‐thirds of patients required an accompanying person for travel to/from the clinic (Droege et al., 2013; Varano et al., 2015; Muller et al., 2017).” (opens the source at this quote in a new tab)
“In another (n = 100 caregivers), approximately 75% of caregivers reported little or no burden associated with supporting patients with nAMD, as evaluated on the Burden Assessment Scale (Senra et al., 2017).” (opens the source at this quote in a new tab)

Caregiver perceptions of the impact of caring: survey of 643 caregivers

“A cross-sectional, self-administered survey of 643 caregivers of people with neovascular AMD, comprising 27 closed-response questions and 2 open ended questions.” (opens the source at this quote in a new tab)
“Very few seek or receive respite and this added burden can have a negative impact upon the relationship between caregiver and care recipient.” (opens the source at this quote in a new tab)

Who transports participants to injection visits, and out-of-pocket transport costs

“The majority of patients (72%, 54 of 75) were driven to their appointment by a caregiver.” (opens the source at this quote in a new tab)
“Their caregiver was a spouse or partner (65%, 35 of 54), an adult child or grandchild (22%, 12 of 54), a friend (7%, 4 of 54), or another person (6%, 3 of 54).” (opens the source at this quote in a new tab)
“Few patients experienced direct out-of-pocket transportation costs. Eighty-nine percent (67 of 75) reported that they did not pay any transportation costs for their latest clinic visit.” (opens the source at this quote in a new tab)

Household income of U.S. participants receiving anti-VEGF injections

“The average income was $40 000. The majority of patients (62%, 46 of 75) reported an income of less than or equal to $50 000.” (opens the source at this quote in a new tab)
“Seventeen percent (13 of 75) reported an income between $50 001 and $75 000 while 10% (8 of 75) had an income greater than $75 000.” (opens the source at this quote in a new tab)