Diabetic retinopathy and age-related macular degeneration: a survey of pharmacoutilization and cost in Calabria, Italy

Abstract

The aged population is constantly growing, thus fostering an increase in age-dependent diseases. Among these, diabetic retinopathy (DR) along with age-related macular degeneration entails progressive vision loss. Since such conditions are associated with the proliferation of novel vessels, their pharmacotherapeutic management consists of the intravitreal injection of anti-vascular endothelial growth factor drugs, able to hinder the driving of vascular proliferation prompted by vascular endothelial growth factor. The humanized anti-vascular endothelial growth factor monoclonal antibody ranibizumab provided evidence for efficacy in several trials, hence earning approval by the US Food and Drug Administration for therapeutic use in all the stages of DR. Due to the lack of epidemiologic and pharmacoeconomic evaluation in the local Calabria Region context, the present retrospective observational study focused on prevalence of DR and age-related macular degeneration, treatment and cost of therapy with ranibizumab in 870 patients arriving to clinical observation at the "Mater Domini" University Hospital in Calabria, Italy from January 2014 to June 2017. Data were extracted from the database of ophthalmology ward and subjected to statistical analysis. The results suggest that the most frequent retinal diseases are age-related macular degeneration and DR and that the use of ranibizumab has been decreasing over the 4-year study period together with the associated cost per patient which was similar for both disorders. Therefore, appropriateness of treatment with drugs other than ranibizumab needs to be assessed in this setting and deep monitoring of pharmacologic treatment for retinal diseases is necessary to prevent or delay visual acuity decrease and complete vision loss. Study procedures were performed in accordance with the "Mater Domini" University Hospital ethical standards of the responsible committee on human experimentation.

Keywords: age-related macular degeneration; anti-VEGFs; diabetic retinopathy; pharmacovigilance; ranibizumab; retrospective study.

Figure 1

Percentage distribution of retinal diseases in the cohort of patients of “Mater Domini” University Hospital. Data were collected during a retrospective observational survey from January 2014 to June 2017. AMD: Age-related macular degeneration; DR: diabetic retinopathy; DME: diabetic macular edema; RVO: retinal vein occlusion.

Figure 2

Frequency (%) of therapeutic use of ranibizumab in the most common retinal diseases. The utilization of ranibizumab is more frequent in AMD than in DR, but it is subjected to a reduction over time. AMD: Age-related macular degeneration; DR: diabetic retinopathy.

Figure 3

Cost per patient with AMD or DR receiving treatment with ranibizumab from January 2014 to June 2017. The cost per patient is quite equal in AMD and DR and it is subjected to a reduction over time. AMD: Age-related macular degeneration; DR: diabetic retinopathy.