Posters

Twelve-month outcomes and economic analysis of aflibercept fixed-dosing vs. ranibizumab treat and extend for neovascular age-related macular degeneration

Poster Details

First Author: H.Almuhtaseb UK

Co Author(s):    L. Michaels   T. Vardarinos   A. Lotery                       

Abstract Details



Purpose:

To directly compare visual acuity (VA) outcomes in year 1 of treatment with aflibercept vs. ranibizumab for eyes with neovascular macular degeneration (nAMD) treated in two centres by two different treatment regimens.

Setting:

Retrospective data analysis. 100 Treatment-naïve eyes received aflibercept or ranibizumab. In Group A (University Hospital Southampton: 51 eyes) aflibercept was used per VIEW protocol. In Centre B (West Suffolk Hospital: 49 eyes) ranibizumab was used per treat and extend (T&E) protocol.

Methods:

Group A received aflibercept per VIEW protocol (Q8W) with a total of 3 Clinic Visits (3 OCTs) during a year of treatment. Group B received Lucentis per T&E protocol: After a loading of 3 IVIs, inter-IVI interval was extended/shortened by 2 weeks based on disease activity. Mean change in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) at year 1 compared to baseline, mean number of injections and visits were collected. Economic analysis was performed based on data from the coding department.

Results:

Baseline parameters were well matched (age, baseline BCVA). The mean VA of Group A eyes improved from 0.49 logMAR at baseline to 0.34 logMAR (+7.5 ETDRS L gain [P = 0.0010]) at end of year 1 (Y1), compared with 0.48 logMAR at baseline to 0.32 logMAR (+8.3 ETDRS L gain [P < 0.0001]) for Group B. Mean BCVA Group A vs mean BCVA Group B (P=0.1550). The mean CRT of Group A improved from 296 μm at baseline to 214 at Y1. The mean CRT of Group B improved from 428 μm at baseline to 272 at Y1. In Group A vs. Group B comparisons, the mean numbers of IVIs were 7 vs. 7.75 (P < 0.0001) and clinic visits were 3 vs. 5.75 (P=0.0001). In the T&E group, IVI and Clinic Visit numbers ranged from 5-11. Economic analysis revealed the total mean cost per patient per annum was £6919.00 for aflibercept per Southampton protocol, £7395.00 for ranibizumab per the T&E protocol.

Conclusions:

Visual gains were significant and comparable for both aflibercept (Q8W) and ranibizumab (T&E) used proactively in year 1. Differences between the 2 regimens were significant when mean numbers of IVIs and clinic visits were compared. From an economic point of view, Southampton protocol for aflibercept is more cost effective compared to T&E for ranibizumab in Y1 of treatment. Larger case series and/or RCTs are needed to give further evidence.

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