title: Disease Burden in the Treatment of Age-Related Macular Degeneration: Findings From a Time-and-Motion Study.
abstract: OBJECTIVE
  To examine the time burden of managing neovascular age-related macular degeneration (AMD) imposed on physicians, staff, patients, and caregivers.
  
  
  METHODS
  Mixed-methods, prospective, observational time-and-motion study.
  
  
  METHODS
  The multicenter study was conducted from March 2011 through August 2012. Retina specialists administering ≥50 vascular endothelial growth factor (VEGF)-inhibitor injections monthly were surveyed and completed records for ≥5 patients scheduled for office visits within 3 weeks for anti-VEGF injection or monitoring. A survey was administered to 75 neovascular AMD patients aged ≥50 years who received ≥1 anti-VEGF injection in the past 6 months. Telephone interviews were conducted with 13 neovascular AMD patient caregivers.
  
  
  RESULTS
  Fifty-six physicians provided data for 221 patients with neovascular AMD. Patients accounted for 20% of the health care staff's time per week, with an average of 23 staff members. An average patient visit for neovascular AMD was 90 minutes (range: 13 minutes to >4 hours). Patients reported an average time per visit of almost 12 hours, including preappointment preparation (16 minutes), travel (66 minutes), waiting time (37 minutes), treatment time (43 minutes), and postappointment recovery (9 hours). Patients stated that caregivers took time away from work (22%) and personal activities (28%) to provide transportation to appointments.
  
  
  CONCLUSIONS
  Neovascular AMD management imposes a substantial time burden on physicians, staff, patients, and caregivers. There may be a need for additional support and/or reimbursement for services required by patients and caregivers and provided by physicians.
authors.affiliation: NJ Retina, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey. Electronic address: jonathanprenner@gmail.com.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Prenner
authors.affiliation: Retina Group of Florida, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida.
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Halperin
authors.affiliation: RTI Health Solutions, Manchester, United Kingdom.
authors.forename: Catherine
authors.initials: C
authors.lastname: Rycroft
authors.affiliation: RTI Health Solutions, Research Triangle Park, North Carolina.
authors.forename: Susan
authors.initials: S
authors.lastname: Hogue
authors.affiliation: Regeneron Pharmaceuticals, Inc, Tarrytown, New York.
authors.forename: Zinaria
authors.initials: Z
authors.lastname: Williams Liu
authors.affiliation: Regeneron Pharmaceuticals, Inc, Tarrytown, New York.
authors.forename: Robert
authors.initials: R
authors.lastname: Seibert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000191:economics* / Q000627:therapeutic use; D017028:Caregivers; D017281:Cost of Illness; D005260:Female; D005451:Fluorescein Angiography; D006282:Health Personnel; D006306:Health Surveys; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013996:Time and Motion Studies; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A