Only one-third of Medicare beneficiaries with neovascular age-related macular degeneration (nAMB) were “persistent” with anti-VEGF monotherapy treatment each year, according to a study presented at the 39th Annual Scientific Meeting of the American Society of Retina Specialists.
Researchers sought to characterize treatment patterns, perceived visual function, and health function of patients with nAMD receiving intravitreal injection (IVI) or anti-VEGF monotherapy. This is the first-time use of the Medicare Current Beneficiary Survey (MCBS) to understand anti-VEGF treatment patterns, perceived visual functioning, and health functioning related to activities of daily living (ADL) and instrumental ADL (iADL) over time, they noted.
The study team retrospectively assessed pooled, 3-year, longitudinal data from the MCBS linked with Medicare fee-for-service claims from 2006-2013 and 2015-2018. Community-dwelling beneficiaries diagnosed with nAMD and receiving one or more anti-VEGF IVI at baseline, and with full-year Medicare Part A and B enrollment for 3 years (baseline + 2 follow-up years), were identified. Those with other vision-threatening diseases and living in long-term care facilities at baseline or with health maintenance organization enrollment in the 3-year period were excluded. Baseline characteristics, anti-VEGF persistence (≥ 6 IVIs in 1 year) at follow-up, as well as perceived function in vision, ADL, and iADL at baseline and follow-up, were evaluated.
More Patients Had Trouble With ADL/iADL at 2 Years
Of 161 patients with nAMD, the majority were non-Hispanic White (97.0%). In the first and second follow-up years:
- 9% and 30.5% of patients were “persistent” on anti-VEGF treatment
- patients received a mean standard error (SE) of 4.2 (0.3) and 3.7 (0.3) injections and had 7.9 (0.3) and 6.8 (0.3) clinic visits
- mean SE interval between consecutive injections/visits was 8.7 (0.3)/7.3 (0.3) and 8.4 (0.4)/8.2 (0.4) weeks, respectively.
The proportions of patients reporting trouble seeing or blindness at baseline and at first and second follow-up years were 30.6%, 32.9%, and 27.6%, respectively. Overall, 68.6% of patients reported similar or better function in the second follow-up year versus baseline. However, a higher proportion of patients had trouble in all ADL and most iADL in the second follow-up year versus baseline. ADLs with greater changes were dressing and using the toilet; iADLs with greater changes were preparing meals, shopping, and managing money.
“Overall, we found that two-thirds of patients treated with anti-VEGF at baseline reported similar or better visual function after 2 years,” the study authors wrote. “However, more patients experienced difficulty in ADL and iADL at 2 years. Future research exploring how nAMD-related factors impact overall functioning is warranted.”
