Wet age-related macular degeneration, or wAMD, is one of the leading causes of blindness in the U.S. Breakthrough treatments come with a steep price tag and treatment burden for the patient, but a new study suggests their benefits to patient health and society would top billions of dollars, or more, if adherence could be improved.
Age-related macular degeneration (AMD) affects approximately 11 million people in the U.S. The wet form of the disease, which is caused by the abnormal growth of blood vessels under the retina, progresses rapidly. Symptoms include blurred vision and blind spots, which can often lead to legal blindness.
While only 10% of people with macular degeneration develop the wet form, the symptoms for these patients are much worse; in the past, wAMD has caused 90% of blindness associated with macular degeneration.
New treatments for wAMD not only prevent further vision loss, but have also been shown to improve vision with the benefits of these innovative treatments lasting for multiple years, according to clinical trials. But the administration of these treatments is burdensome and requires patients to receive injections in their eye as frequently as every four to eight weeks. More than half of Medicare patients discontinue treatment within the first year due to cost, the inability to get transportation to and from their retina specialists, and fear or discomfort from receiving these injections.
The new economic study, published in JAMA Ophthalmology, quantifies the benefits of treatment for wAMD. It found improvements in vision from innovative treatments generated $ 5.1 to $ 8.2 billion in patient benefits. This translates to $ 0.9 to $ 3.0 billion in societal value (patient benefits minus treatment costs) over three years. Future innovative treatments that lead to improved adherence would generate an additional $ 7.3 to $ 15.0 billion in patient benefits, they estimate.
WHAT’S THE IMPACT
Treatments for wAMD first came on the market around 2006. Called anti-vascular endothelial growth factor (VEGF), these treatments target the abnormal growth of the blood vessels and have been shown to restore patients’ eyesight for a number of years.
In clinical trials, these treatments were administered to patients monthly via an injection in the eye. But in practice, adherence tends to decline because of the discomfort associated with the eye injections, difficulty in getting to retina specialists for timely care, and cost. To address this patient burden, some doctors have modified treatment plans that allow for lower injection frequency, taking into account the patient’s documented vision improvements, cost, and the burden of administering the treatment.
Taking into account the costs associated with treatment, the researchers modeled treatment scenarios to provide practitioners, patients, and payers with information about the value of anti-VEGF therapy. Their findings quantified the benefits derived from the therapy to individual patients and society.
They modeled multiple treatment scenarios: a no injection scenario; less frequent injections (in which patients received approximately eight injections per year); more frequent injections (in which patients received an average of 10.5 injections per year); improved adherence (in which 85% of patients initiate therapy and adherence improves); and innovation scenarios (based on clinical trial data representing best case scenarios with patients receiving either more or less frequent injections).
The researchers found that even under current treatment conditions of less frequent injections, treatment generates over $ 1 billion for the full population with wAMD in year one and $ 5.1 billion in year three. With improved adherence, benefits to the patient population were estimated to reach $ 7.3 to $ 11.4 billion in year three.
This translates to a benefit to society (patient benefit minus treatment costs) of $ 0.9 to $ 3.0 billion across three years in the current treatment scenarios and upwards of over $ 4 billion in the innovative treatment scenario (i.e., when a drug that leads to better adherence is discovered).
The authors find innovations to improve treatment adherence could generate an additional $ 1.2 to $ 3.7 billion in patient benefit and $ 59 million to $ 1.3 billion in societal value compared to current treatment scenarios — highlighting the fact that when patients follow through with necessary treatment, individuals, providers and society as a whole can reap the rewards.
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