Extended indications for anti-VEGF treatment in proliferative diabetic retinopathy will affect services, costs
VIENNA — Following the conclusions of DRCR.net Protocol S, anti-VEGFs are likely to be used more and earlier in the treatment of proliferative diabetic retinopathy. At the Advanced Retinal Therapy meeting, Simon Harding, MD, chair of Clinical Ophthalmology at Liverpool University, England, expressed concern about the rising costs of therapy in future years.
In Liverpool, in a diabetic population of 22,432, 856 laser procedures were performed in 319 patients in 2015. Based on a previous audit, it can be assumed that about 50% of these patients had proliferative diabetic retinopathy.
Looking at current reimbursement rates in England, the cost of switching from laser to Lucentis (ranibizumab, Genentech/Novartis) with an average of 5.4 injections per year, as suggested by Protocol S, would raise the cost per single treatment from 210 GBP to as much as 900 GBP, inclusive of assessment with OCT. The annual total cost in Liverpool would amount to nearly 800,000 GBP.
“If we take into account the additional laser need by 15% of the patients, this is another 794,209 GBP per annum, and if we add the 45% fellow eyes needing injections only, we reach 1 million GBP approximately,” Harding said. “The incremental cost for Liverpool is around 900,000 GBP. For the country, it would be an extra spent of 130 million GBP per year.”
Extending the projected costs to 2 years, taking into account re-treatment plus new cases, this amount would increase to 271 million GBP. NHS cost per case for 2 years of laser is around 630 GBP, and for ranibizumab, 15,260 GBP. The impact, Harding said, is going to be “very uncomfortable on hard-pressed services.”
To avoid this effect, while waiting for further evidence to clarify indications, maintenance of clinical skills for delivery of laser is recommended, Harding said. – by Michela Cimberle
Disclosure: Harding reports he is on the advisory board of Allergan and Roche/Genentech.