Author: Roberto Gallego-Pinazo (Spain)
Co-authors: Begoña Pina-Marin, Marta Comellas, Susana Aceituno, Laia Gómez-Baldó, Carles Blanch
Purpose
Neovascular age-related macular degeneration (nAMD) leads to severe and permanent visual impairment, significantly impacting patients' quality of life and functional independence. Although treatment with anti-VEGF prevents and, in some cases, reverses visual damage, the need for frequent monitoring visits and intravitreal injections represents a significant burden on patients, caregivers and retina specialists. The objective of this study was to elicit preferences for nAMD treatment characteristics from the perspectives of patients and retina specialists.
Setting/Venue
Patients diagnosed with nAMD who started treatment with anti-VEGF drugs, indicated for nAMD, between November 1st, 2016 and March 31st, 2017 in 20 tertiary (high complexity) public and private hospitals of all the Spanish regions.
Methods
A discrete choice experiment was conducted. Participants were asked to select one of two hypothetical treatments resulting from the combination of five attributes (effects on visual function, effects on retinal fluid, treatment regimen, monitoring frequency and cost); their levels were identified by reviewing the literature and two focus groups. The relative importance (RI) given to each attribute was estimated using a mixed logit model. The marginal rates of substitution (MRS) were calculated taking cost as the risk attribute.
Results
A total of 110 patients (P) [79.0 (SD:7.4) years; 57.3% women; 2.3 (SD:0.7) years with nAMD; 2.1 years (SD:0.1) in treatment] and 66 retina specialists (RS) participated in the study. Participants gave greater RI to improvements in visual function [60.0% (P); 52.7% (RS)], lower monitoring frequency [20.2% (P); 27.1% (RS)] and reduction in retinal fluid [9.8% (P); 13.0%(RS)]. Patients and retina specialists would agree to an increase in cost by 65.0% and 56.5%, respectively, in exchange for improving visual function; and 25.5% and 43.3% for delaying monitoring frequency by one month.
Conlusions
For patients and retina specialists, treatment election is determined by its ability to improve visual function. Treatment monitoring requirements are also considered, mainly from the retina specialist perspective. These results suggest that the use of more efficacious anti-VEGF agents with a longer duration of action would facilitate better disease management, fulfilling the unmet needs of patients and retina specialists.
Financial Disclosure
Roberto Gallego-Pinazo: Consultant: Novartis, Roche. Speaker: Allergan, Bloss, Heidelberg Engineering, Horus Pharma, Novartis, Roche. Research Support: Novartis, Roche, Syneos Health, Thrombogenics. Begoña Pina-Marin: No financial relations Marta Comellas: No financial relations Susana Aceituno: No financial relations Laia Gómez-Baldó: Employee of Novartis Carles Blanch: Employee of Novartis
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