title: Bevacizumab for neovascular age-related macular degeneration using a treat-and-extend regimen: clinical and economic impact.
abstract: OBJECTIVE
  To evaluate the visual outcomes, number of injections, and direct medical cost of a treat-and-extend regimen in managing neovascular age-related macular degeneration with intravitreal bevacizumab.
  
  
  METHODS
  Retrospective, interventional, consecutive case series.
  
  
  METHODS
  Seventy-four eyes of 73 patients with treatment-naïve neovascular age-related macular degeneration from a single clinical practice were treated monthly with intravitreal bevacizumab until no intraretinal or subretinal fluid was observed on optical coherence tomography. The treatment intervals then were lengthened sequentially by 2 weeks until signs of exudation recurred and then were reduced accordingly to maintain an exudation-free macula. Main outcomes measured included mean change from baseline visual acuity, proportion of eyes losing fewer than 3 and gaining 3 or more Snellen visual acuity lines at 1 year of follow-up, annual mean number of injections, optical coherence tomography mean central retinal thickness change from baseline, mean maximum period of extension, adverse events, and mean direct annual medical cost.
  
  
  RESULTS
  The mean follow-up period was 1.41 years. Mean Snellen visual acuity improved from 20/230 at baseline to 20/109 at 12 months (P < .001) and 20/106 at 24 months (P < .001). The mean number of injections over the first year was 7.94. The mean optical coherence tomography central retinal thickness decreased from 316 to 239 μm at 12 months (P < .001). The mean direct medical cost over the first year was $3493.85.
  
  
  CONCLUSIONS
  Eyes with neovascular age-related macular degeneration experienced significant visual improvements on average when managed with intravitreal bevacizumab using a treat-and-extend regimen with fewer patient visits and injections along with lower costs compared with a fixed, monthly dosing regimen.
authors: Retina Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors: Gary
authors: G
authors: Shienbaum
authors: Omesh P
authors: OP
authors: Gupta
authors: Christopher
authors: C
authors: Fecarotta
authors: Avni H
authors: AH
authors: Patel
authors: Richard S
authors: RS
authors: Kaiser
authors: Carl D
authors: CD
authors: Regillo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000191:economics*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000191:economics*; D000068258:Bevacizumab; D005249:Fees and Charges; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D056687:Off-Label Use; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab