title: Comparison of Outcomes and Costs of Ranibizumab and Aflibercept Treatment in Real-Life.
abstract: BACKGROUND
  Treatment efficacy and costs of anti-VEGF drugs have not been studied in clinical routine.
  
  
  OBJECTIVE
  To compare treatment costs and clinical outcomes of the medications when adjusting for patients' characteristics and clinical status.
  
  
  METHODS
  Comparative study.
  
  
  METHODS
  The largest public ophthalmologic clinic in Switzerland.
  
  
  METHODS
  Health care claims data of patients with age-related macular degeneration, diabetic macula edema and retinal vein occlusion were matched to clinical and outcome data.
  
  
  METHODS
  Patients' underlying condition, gender, age, visual acuity and retinal thickness at baseline and after completing the loading phase, the total number of injections per treatment, the visual outcome and vital status was secured.
  
  
  RESULTS
  We included 315 patients (19595 claims) with a follow-up time of 1 to 99 months (mean 32.7, SD 25.8) covering the years 2006-2014. Mean age was 78 years (SD 9.3) and 200 (63.5%) were female. At baseline, the mean number of letters was 55.6 (SD 16.3) and the central retinal thickness was 400.1 μm (SD 110.1). Patients received a mean number of 15.1 injections (SD 13.7; range 1 to 85). Compared to AMD, adjusted cost per month were significantly higher (+2174.88 CHF, 95%CI: 1094.50-3255.27; p<0.001) for patients with DME, while cost per month for RVO were slightly but not significantly higher. (+284.71 CHF, 95% CI: -866.73-1436.15; p = 0.627).
  
  
  CONCLUSIONS
  Patients with DME are almost twice as expensive as AMD and RVO patients. Cost excess occurs with non-ophthalmologic interventions. The currently licensed anti-VEGF medications did not differ in costs, injection frequency and clinical outcomes. Linking health care claims to clinical data is a useful tool to examine routine clinical care.
authors.affiliation: Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
authors.forename: Martin K
authors.initials: MK
authors.lastname: Schmid
authors.affiliation: Department of Health Sciences, Helsana Group, Zurich, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Reich
authors.affiliation: Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
authors.forename: Livia
authors.initials: L
authors.lastname: Faes
authors.affiliation: Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
authors.forename: Sophie C
authors.initials: SC
authors.lastname: Boehni
authors.affiliation: Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
authors.forename: Mario
authors.initials: M
authors.lastname: Bittner
authors.affiliation: Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
authors.forename: Jeremy P
authors.initials: JP
authors.lastname: Howell
authors.affiliation: Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Thiel
authors.affiliation: Department of Health Sciences, Helsana Group, Zurich, Switzerland.
authors.forename: Andri
authors.initials: A
authors.lastname: Signorell
authors.affiliation: medignition Inc. Research Consultants, Zürich, Switzerland.
authors.forename: Lucas M
authors.initials: LM
authors.lastname: Bachmann
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D003930:Diabetic Retinopathy / Q000188:drug therapy* / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D008268:Macular Degeneration / Q000188:drug therapy* / Q000191:economics; D008269:Macular Edema / Q000188:drug therapy* / Q000191:economics; D008297:Male; D000069579:Ranibizumab / Q000191:economics / Q000627:therapeutic use*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000191:economics / Q000627:therapeutic use*; D011993:Recombinant Fusion Proteins / Q000191:economics / Q000627:therapeutic use*; D012170:Retinal Vein Occlusion / Q000188:drug therapy* / Q000191:economics; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity
chemical_list: D011993:Recombinant Fusion Proteins; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab