Pain, Anxiety Represent Barriers to Anti-VEGF Therapies for Costly Eye Conditions

Pain and fear/anxiety were the most common barriers to anti–vascular endothelial growth factor (VEGF) therapy for retinal diseases, according to a poster presented at the Academy of Managed Care Pharmacy Nexus 2021 meeting, held October 21-28 in Denver, Colorado.¹

Other barriers to receiving the treatment for neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) included visit frequency and travel logistics, doctor-patient relationships, financial burden, and serious comorbidities.

Researchers conducted one-on-one phone interviews with patients who were treated for a year or more with anti-VEGF treatments, along with their caregivers and retina specialists, from June through October 2020.

Patients and caregivers said the most common barriers to treatment were the adverse effects of pain and discomfort (67% and 68%, respectively), along with fear and anxiety about injections (61% and 42%, respectively).

Financial burden (83%) and comorbidities (17%) were cited as the most prevalent barriers to treatment by retina specialists. However, patients and caregivers did not believe financial burden and comorbidities were a major challenge.

Thirty-three percent of patients and 11% of caregivers said visit frequency and travel logistics were barriers. The lack of education about treatment purpose, risk, and procedures was reported by 28% of patients but no caregivers.

Patients were also concerned about the patient-doctor relationship, with 22% reporting that as a barrier to treatment.

In a separate poster, presenters noted that patients with nAMD and DME were more likely to report severe visual impairment, limitations in daily living activities (ADL), and falls.² They also had higher Medicare costs than those without vision-threatening retinal diseases.

In the study of Medicare fee-for-service claims from 2016 to 2018, total Medicare costs were $27,010 per patient with nAMD and $31,532 per patient with DME, compared with $15,900 in the control group.

“This study highlights the potential impact of nAMD and DME on vision and functional status of Medicare beneficiaries and related health care costs,” the presenters said.

Perceived visual function of nAMD and DME patients was worse than that of controls: 26.2% and 16.9% vs 5.0%, respectively, reported that they had a lot of trouble seeing or were blind (P < .001). Limitations in ADL, such as walking, were significantly more common in patients with nAMD (33.1%) and DME (39.1%) vs controls (27.1%).

The proportion of patients experiencing falls was also significantly higher in patients with nAMD (33.3%) and DME (41.4%) compared with controls (27.7%).

Notably, anxiety was much higher in the nAMD group vs the control group (10.5% vs 5.9%). The findings indicate that vision-threatening retinal diseases ”represent a significant burden on patients and health care system,” the poster presenters wrote.

References

1. Garmo V, Fox J, Lanar S, et al. Identifying barriers to anti-VEGF therapies in neovascular age related macular degeneration (nAMD) and diabetic macular edema (DME): a mixed method approach to understand patient treatment experience. Presented at: AMCP Nexus 2021; October 18-21, 2021; Denver, CO. Poster H2.

2. Biskupiak J, Ng C, Oderda G, et al. Assessing perceived vision, functional status, and related health care cost of patients with neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME): analysis of the Medicare Current Beneficiary Survey (MCBS) data. Presented at: AMCP Nexus 2021; October 18-21, 2021; Denver, CO. Poster H1.