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Study: Patients with wet AMD would opt for high treatment burden to prevent worse visual acuity
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Patients with neovascular age-related macular degeneration were willing to opt for a higher treatment burden, which included regular intravitreal injections at short intervals and long periods of waiting, treatment and traveling, to prevent worsening of visual acuity, according to a study conducted in Germany.
Two hundred eighty-four patients were included in the discrete choice experiment. All patients had wet AMD, had received at least one intravitreal injection and were at least 50 years old. Researchers conducted telephone interviews with the subjects.
At study inclusion, 22.9% of patients had poor visual acuity, 54.9% of patients had moderate visual acuity, 14.1% of patients had good visual acuity, and visual acuity was not available for 8.1% of patients.
“Generally, patients preferred the attribute levels 'improvement in VA' and 'short time per specialist visit,'” the study authors said.
The attribute “change of VA” influenced overall decisions for or against treatment in 73.6% of patients, “waiting, treatment and travel time” influenced decisions in 21% of patients, and “treatment scheme” influenced decisions in 5.4% of patients.
Overall, patients were willing to opt for an additional 12.7 hours of time spent for each physician visit to achieve stable visual acuity rather than worse acuity. Patients were willing to opt for an additional 21.1 hours spent for each physician visit to improve visual acuity. Each physician visit was defined as including longer waiting, treatment and travel times.
“Patients are aware of the high treatment burden associated with intravitreal injection therapy, but although the treatment burden associated with current treatment options is high, they show a strong preference for a treatment that is likely to have a more favorable clinical outcome,” the authors said. – by Nhu Te
Disclosure: Mueller reports she is a staff member of the Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM). The IPAM work in the study was sponsored by Bayer. See the full study for all authors’ relevant financial disclosures.
Perspective
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Pravin U. Dugel, MD
The article confirms the importance of vision. Other studies have shown what patients are willing to do to preserve their vision, not just in macular degeneration, but also in numerous other diseases. The fact that patients are willing to come in every month and get a needle stuck in their eye tells us how much they value sight. Another aspect that I think is important to discuss is the sustainability of our current treatment. Our treatment strategy in many of these blinding diseases is for patients to come in approximately monthly, whether they are injected or not. Unfortunately, as much as patients want to come in and as much as they want to preserve vision, other studies have shown us that this treatment strategy simply is not sustainable. Medicare database analyses have confirmed that instead of getting injections every month, as many of the clinical trials suggest we do to achieve the best vision, patients are getting injections far less than half that amount. On one hand, patients value vision greatly. On the other hand, there is a very large disconnect between clinical trials and real life, as shown from our current strategy of treatment for neovascular macular degeneration, diabetic macular edema, as well as vein occlusion. Patients, as much as they value vision, simply cannot follow the clinical strategy that we have set forth. I think the single most important priority for us as a retina community is to immediately and honestly address this problem, and then to study real-life sustainable treatment strategies.
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Muller S, et al. Ophthalmology. 2016;doi:10.1016/j.ophtha.2015.12.001.
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