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. 2014 Jun 30;9(6):e101072.
doi: 10.1371/journal.pone.0101072. eCollection 2014.

Estimated cases of blindness and visual impairment from neovascular age-related macular degeneration avoided in Australia by ranibizumab treatment

Paul Mitchell  1 , Neil Bressler  2 , Quan V Doan  3 , Chantal Dolan  4 , Alberto Ferreira  5 , Aaron Osborne  5 , Elena Rochtchina  1 , Mark Danese  3 , Shoshana Colman  6 , Tien Y Wong  7
Affiliations

Estimated cases of blindness and visual impairment from neovascular age-related macular degeneration avoided in Australia by ranibizumab treatment

Paul Mitchell et al. PLoS One. .

Abstract

Intravitreal injections of anti-vascular endothelial growth factor agents, such as ranibizumab, have significantly improved the management of neovascular age-related macular degeneration. This study used patient-level simulation modelling to estimate the number of individuals in Australia who would have been likely to avoid legal blindness or visual impairment due to neovascular age-related macular degeneration over a 2-year period as a result of intravitreal ranibizumab injections. The modelling approach used existing data for the incidence of neovascular age-related macular degeneration in Australia and outcomes from ranibizumab trials. Blindness and visual impairment were defined as visual acuity in the better-seeing eye of worse than 6/60 or 6/12, respectively. In 2010, 14,634 individuals in Australia were estimated to develop neovascular age-related macular degeneration who would be eligible for ranibizumab therapy. Without treatment, 2246 individuals would become legally blind over 2 years. Monthly 0.5 mg intravitreal ranibizumab would reduce incident blindness by 72% (95% simulation interval, 70-74%). Ranibizumab given as needed would reduce incident blindness by 68% (64-71%). Without treatment, 4846 individuals would become visually impaired over 2 years; this proportion would be reduced by 37% (34-39%) with monthly intravitreal ranibizumab, and by 28% (23-33%) with ranibizumab given as needed. These data suggest that intravitreal injections of ranibizumab, given either monthly or as needed, can substantially lower the number of cases of blindness and visual impairment over 2 years after the diagnosis of neovascular age-related macular degeneration.

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Conflict of interest statement

Competing Interests: The authors have read the journal's policy and have the following conflicts: Dr. Bressler's employer, the Johns Hopkins University (JHU), but not Dr. Bressler himself, receives funding from Bayer, Genentech, Inc., Roche, Novartis and Regeneron, and Steba Pharmaceuticals for sponsored projects by the Department of Ophthalmology for the efforts of Dr. Bressler. Dr. Bressler receives salary support for these sponsored projects; the terms of these projects are negotiated and administered by JHU's Office of Research Administration. Under JHU's policy, support for the costs of research, administered by the institution, does not constitute a conflict of interest. Paul Mitchell has received consultancy fees, lecture fees and travel support from Novartis Pharma AG, Pfizer, Solvay (Abbott), Bayer, Alcon and Allergan. Novartis Pharma AG also funds a retina fellowship at Westmead Hospital, Sydney, which he supervises. Alberto Ferreira is an employee of Novartis Pharma AG. Aaron Osborne is currently with Alcon Research Ltd and is a former employee of Novartis Pharma AG. Shoshana Colman is an employee of Genentech, both Novartis Pharma AG and Genentech sponsored this study. Quan Doan and Mark Danese are employees of Outcomes Insights, Inc., and Chantal Dolan is an employee of CMD Consulting, Inc.; these companies were paid for analysis work. Genentech and Novartis market ranibizumab. No financial benefit is anticipated as a result of this study. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Model schematic.
Incident cases of neovascular age-related macular degeneration (AMD) were derived by multiplying the number of individuals in each age group and gender by the respective incidences in the Blue Mountains Eye Study. Incident cases of neovascular AMD from 1 year were in the model for 2 years. Among individuals with AMD in one eye, 33% were estimated to have AMD in the fellow eye at baseline , , . SI: simulation interval; VA: visual acuity; vPDT: photodynamic therapy with verteporfin.
Figure 2
Figure 2. Sensitivity analyses.
The impact of neovascular age-related macular degeneration lesion type on the cases of blindness (best-corrected visual acuity in better-seeing eye worse than 6/60) avoided using a monthly ranibizumab scenario compared with a no-treatment scenario. In the base analysis, 1622 cases of legal blindness were avoided with monthly ranibizumab, as indicated by the vertical line. aEligible for PDT and ranibizumab. bIneligible for any treatment. cEligible for ranibizumab, but not for PDT. PDT: photodynamic therapy.
Figure 3
Figure 3. Sensitivity analyses.
The impact of neovascular age-related macular degeneration lesion type on the cases of visual impairment (best-corrected visual acuity in better-seeing eye worse than 6/12) avoided using a monthly ranibizumab scenario compared with a no-treatment scenario. In the base analysis, 1774 cases of visual impairment were avoided with monthly ranibizumab, as indicated by the vertical line. aEligible for PDT and ranibizumab. bIneligible for any treatment. cEligible for ranibizumab, but not for PDT. PDT: photodynamic therapy.
See this image and copyright information in PMC

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