Author: MAULIK BHAVSAR (India)
Co-authors: Nitin Maksane
Purpose
Neovascular age-related macular degeneration (nAMD) is a rapidly progressing and potentially blinding degenerative eye disease in population ≥60 years of age, affecting over 17 million people worldwide. Although anti-vascular endothelial growth factor (anti-VEGF) therapy is the standard of care, there are still significant gaps and challenges faced by the healthcare professionals (HCPs) while managing patients with nAMD, including but not limited to diagnosis, treatment, choice of regimen, financial considerations, and lack of treatment compliance. Evidently, aging is the most important risk factor for nAMD. Thus, in developing countries like India, increasing geriatric population is yet another concern for HCPs. In addition, treatment affordability and overall financial burden imposed on the patients with anti-VEGF treatment (due to out-of-pocket expenses, insufficient insurance coverage), as well as scarcity of healthcare infrastructure (tertiary-care centres located primarily in metro and tier-1 cities) further contribute to the treatment challenges faced by Indian HCPs. Thus, exploring the aforesaid factors can help HCPs to build effective strategies for nAMD management. The present survey sheds a light on the nAMD patient load in India, along with treatment goals and therapy-related drivers considered important while initiating any anti-VEGF therapy as well as while managing patients already on the therapy.
Setting/Venue
HCP-based survey conducted in total 11 cities across India in real world settings.
Methods
This nationwide cross-sectional, quantitative survey was conducted between August 2020 and October 2020. The HCPs (N=222) included were retina specialists (RET: n=122 with ≥70% retina practice) and general ophthalmologists (OPH: n=100 with ≥40% retina practice), who manage patients with nAMD and administer intravitreal anti-VEGF injections (RET: ≥20 injections/month, GEN-OPH: ≥10 injections/month). The survey was conducted using a mix of computer-assisted personal interviews (75%) and computer assisted web-based or telephonic interviews (25%) for 30-35 minutes using a validated questionnaire. The survey evaluated patient load of nAMD and average number of new patients initiating anti-VEGF therapy per month, drivers for initiating this therapy such as key treatment goals/objectives that HCPs wished to achieve while initiating anti-VEGF therapy, important markers/indicators to measure progress and achievement of these treatment goals (importance rated on the scale of 1 [not at all important] to 5 [extremely important]), and other attributes considered while choosing any anti-VEGF therapy. This information was further analysed to compare the practice patterns among the OPH and RET.
Results
Patients with nAMD accounted for 13% of total patient-pool per HCP per month (OPH: 12%, RET: 14%). Each HCP on average initiated 15 new nAMD patients with anti-VEGF therapy per month. Key treatment goals most HCPs considered during therapy initiation were improvement in vision (67%), reduction/drying of fluid (51%), and anatomical improvement (37%). To measure achievement of treatment goals, gain in visual acuity was rated ‘extremely important’ marker by 75% HCPs (OPH: 73%, RET: 77%). Retinal fluid drying was second-most chosen ‘extremely important’ marker by OPH (63%); RET (65%) chose better penetration to retina and choroid. Within fluid types, reduction in sub-retinal fluid was key priority and most critical attribute (ranked number 1 by 55% HCPs). While choosing anti-VEGF therapy, ~25% HCPs considered gain in visual acuity, reduction in fluid, and reduction in central retinal thickness (CRT) as key attributes of therapy. Gain in visual acuity was relatively higher among RET (28%) vs OPH (19%), reduction in CRT was relatively higher among OPH (29%) vs RET (19%). Cost of therapy/affordability was another most critical attribute while choosing anti-VEGF therapy as per OPH (ranked number 1 by 42%); RET gave equal emphasis (~25%) to cost/longer duration of action/extensive clinical evidence/dosing frequency.
Conlusions
The survey offered constructive insights from the HCPs perspective while managing and initiating the anti-VEGF therapy in Indian patients with nAMD. The factors and attributes considered by the OPH and RET were on similar lines for determining the treatment goals, assessing the key markers/indicators to measure treatment progress, as well as factors accounted while selecting a particular anti-VEGF therapy. Of note, there was a difference in opinion among the HCPs for the non-therapy related attributes of anti-VEGF therapy: OPH considered cost of therapy/affordability as an important attribute for selection of anti-VEGF therapy, while RET considered the cost, longer duration of action, extensive clinical evidence, and frequency of dosing as equally important attributes for selection.
Financial Disclosure
Maulik Bhavsar and Nitin Maksane are employees of Novartis India Limited
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