Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 May;48(4):477-485.
doi: 10.1111/ceo.13706. Epub 2020 Jan 13.

Impact of out-of-pocket costs on patient initiation, adherence and persistence rates for patients treated with anti-vascular endothelial growth factor medicines

Shaun Jackson  1 , John P Stokes  1   2
Affiliations

Impact of out-of-pocket costs on patient initiation, adherence and persistence rates for patients treated with anti-vascular endothelial growth factor medicines

Shaun Jackson et al. Clin Exp Ophthalmol. 2020 May.

Abstract

Importance: Out-of-pocket costs are a key driver of patient decisions to access, adhere and persist with anti-vascular endothelial growth factor (VEGF) therapy. The Medicare Benefits Schedule Review Taskforce proposes a 69% reduction in the scheduled fee for intravitreal injections (item 42 738) which risks increasing out-of-pocket costs for patients and worsening visual outcomes.

Background: To determine the impact of out-of-pocket costs on current anti-VEGF utilization rates in patients with neovascular age-related macular degeneration (nAMD) and diabetic macular oedema (DMO).

Design: This is a retrospective cohort drug-utilization analysis.

Participants: This study involved 11 592 patients in Australia diagnosed with nAMD or DMO.

Methods: A retrospective analysis of electronic, de-identified dispensing records of patients diagnosed with nAMD or DMO who initiated anti-VEGF therapy between January 1, 2016 and December 2018 across Australia. Patients were categorized by treatment facility type: bulk-billing clinics (BBCs) and "rest of market" clinics (ROMCs).

Main outcome measures: Dispensing quantities, intervals and persistence rates.

Results: For patients with nAMD who initiated therapy between 2016 and 2018 the mean number of medicines dispensed up to September 30, 2019 was 17.0 for BBC and 13.8 for ROMC patients. For patients with DMO, the mean number of medicines dispensed was 16.5 for BBC patients and 12.5 for ROMC patients. Patients treated at BBCs had higher persistence rates than those treated at ROMCs. DMO patients had higher initiation rates BBCs (46%) vs ROMCs (25%).

Conclusions and relevance: Lower out-of-pocket costs are associated with higher adherence and persistence rates for anti-VEGF therapy in patients with AMD and DMO and higher initiation rates for DMO patients.

Keywords: anti-vascular endothelial growth factor; expense; macular degeneration; out-of-pocket.

PubMed Disclaimer

Comment in

References

REFERENCES

    1. Medicare Australia Statistics. Pharmaceutical Benefits Schedule item reports. http://medicarestatistics.humanservices.gov.au/statistics/pbs_item.jsp. Accessed October 17, 2019.
    1. Medicare Australia Statistics. Medicare item report (42738, 42739), items processed from July 2018 to June 2019. http://medicarestatistics.humanservices.gov.au/statistics/do.jsp?. Accessed October 17, 2019.
    1. Medicare Benefits Schedule Review Taskforce. Ophthalmology report. 2019. https://www1.health.gov.au/internet/main/publishing.nsf/Content/mbs-revi.... Accessed October 17, 2019.
    1. Department of Health. MBS online. Items 18240 and 42738. http://www9.health.gov.au/mbs/search.cfm. Accessed October 17, 2019.
    1. Holz FG, Tadayoni R, Beatty S, et al. Key drivers of visual acuity gains in neovascular age-related macular degeneration in real life: findings from the AURA study. Br J Ophthalmol. 2016;100:1623-1628.

Substances

LinkOut - more resources