title: Disparities in access to anti-vascular endothelial growth factor treatment for neovascular age-related macular degeneration.
abstract: BACKGROUND
  Late neovascular age-related macular degeneration (nvAMD) is very common and causes irreversible severe visual loss unless treated swiftly with vascular endothelial growth factor (VEGF) inhibitors. Although publicly subsidized access to treatment may be inequitable, which is why we assessed treatment provision across Australia.
  
  
  METHODS
  Secondary analysis of Australian data.
  
  
  METHODS
  All Pharmaceutical Benefits Scheme (including Repatriation PBS) beneficiaries.
  
  
  METHODS
  Treatment and incidence data were obtained from Medicare Australia, the Royal Australian and New Zealand College of Ophthalmologists, Optometry Australia, the Blue Mountains Eye Study and the Australian Bureau of Statistics. Data were mapped using geographical information software, and factors associated with treatment provision were assessed using multiple linear regression models.
  
  
  METHODS
  Unmet need (%) for anti-VEGF treatment for nvAMD.
  
  
  RESULTS
  On average, we estimated 7316 incident cases of nvAMD not to be treated per year from 2010 to 2014 (50.1% of total). Number of ophthalmologists and optometrists (per 1000, β = -0.024; 95% confidence interval [CI] -0.041, -0.007) and being located in remote regions (β = 0.186; 95% CI 0.110, 0.262) were associated with percentage of untreated cases. A higher proportion of the population speaking a language other than English at home was associated in univariate analyses only (β = 0.0015; 95% CI -0.0004, 0.0027; P = 0.007).
  
  
  CONCLUSIONS
  A large proportion of incident nvAMD is not treated with anti-VEGF. Not receiving treatment is more likely in regional or remote areas and areas with fewer service providers. Not speaking English at home may further limit access. Service delivery models for more equitable service provision are needed.
authors.affiliation: Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.|Department of Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Finger
authors.affiliation: Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.|Department of Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Jing
authors.initials: J
authors.lastname: Xie
authors.affiliation: Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.|Department of Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Kathy
authors.initials: K
authors.lastname: Fotis
authors.affiliation: Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.|Department of Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Sumit
authors.initials: S
authors.lastname: Parikh
authors.affiliation: Macular Disease Foundation Australia, Sydney, New South Wales, Australia.
authors.forename: Rob
authors.initials: R
authors.lastname: Cummins
authors.affiliation: Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
authors.affiliation: Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.|Department of Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Robyn H
authors.initials: RH
authors.lastname: Guymer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D001315:Australia / Q000453:epidemiology; D000068258:Bevacizumab / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D058449:Intravitreal Injections; D008297:Male; D020380:Needs Assessment / Q000706:statistics & numerical data*; D009520:New Zealand / Q000453:epidemiology; D000069579:Ranibizumab / Q000008:administration & dosage*; D012189:Retrospective Studies; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D057135:Wet Macular Degeneration / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D020533:Angiogenesis Inhibitors; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab
keywords: Australia; access; anti-VEGF; neovascular age-related macular degeneration