Julia Krieger, Oliver Cox, Jan-Paul Flacke, Lena Beilschmidt, Sabrina Mueller, Ulf Maywald, Michael Janusz Koss
{"title":"新生血管性老年黄斑变性和糖尿病视网膜病变或糖尿病黄斑水肿患者的实际治疗和持续治疗：德国索赔数据分析。","authors":"Julia Krieger, Oliver Cox, Jan-Paul Flacke, Lena Beilschmidt, Sabrina Mueller, Ulf Maywald, Michael Janusz Koss","doi":"10.1007/s00417-024-06690-9","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Vascular endothelial growth factor (VEGF) inhibition is the current and high-volume standard-of-care for patients with neovascular age-related macular degeneration (nAMD) and diabetic retinopathy (DR) with diabetic macular edema (DME). This study assessed the impact of non-persistence in anti-VEGF treatment using claims data from two German states.</p><p><strong>Methods: </strong>This study identified adults with nAMD or DR/DME and incident anti-VEGF treatment (= index) in January 2015-June 2019 using the German AOK PLUS claims database (January 2014-June 2021, ~ 3.5 million insured). Baseline characteristics were observed within 12 months before index. Patient follow-up lasted ≥ 24 months or until death. Non-persistence (gap of ≥ 180 days) was calculated using Kaplan-Meier estimation. Cox regression identified variables linked to non- persistence. The study analysed reimbursed anti-VEGF treatments, thus excluding off-label use of bevacizumab.</p><p><strong>Results: </strong>5,498 patients diagnosed with nAMD (mean age, 80.09 years; male, 37.50%; mean Charlson Comorbidity Index [CCI] score, 3.07) and 484 patients with DR/DME (mean age, 67.14; male, 58.88%; mean CCI score, 4.54) were identified. Non-persistence to anti-VEGF treatment within 12 months after index occurred in 51.38% of nAMD patients and 62.60% of DR/DME patients, with mean times to first gap of 11.28 and 8.98 months, respectively. Cox regression revealed factors associated with non-persistence, including higher age, female gender, higher care needs, longer AMD history, and the use of ranibizumab.</p><p><strong>Conclusion: </strong>Epidemiologic and ophthalmologic factors associated with anti-VEGF non-persistence were successfully identified in the first year of therapy. The analyzed dataset can potentially be enriched with additional health insurance database sets under the used criteria to gain more understanding of anti-VEGF non-persistence.</p>","PeriodicalId":12795,"journal":{"name":"Graefe’s Archive for Clinical and Experimental Ophthalmology","volume":" ","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Real-world therapy and persistence of patients with neovascular age-related macular degeneration and diabetic retinopathy or diabetic macular edema: a German claims data analysis.\",\"authors\":\"Julia Krieger, Oliver Cox, Jan-Paul Flacke, Lena Beilschmidt, Sabrina Mueller, Ulf Maywald, Michael Janusz Koss\",\"doi\":\"10.1007/s00417-024-06690-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Vascular endothelial growth factor (VEGF) inhibition is the current and high-volume standard-of-care for patients with neovascular age-related macular degeneration (nAMD) and diabetic retinopathy (DR) with diabetic macular edema (DME). This study assessed the impact of non-persistence in anti-VEGF treatment using claims data from two German states.</p><p><strong>Methods: </strong>This study identified adults with nAMD or DR/DME and incident anti-VEGF treatment (= index) in January 2015-June 2019 using the German AOK PLUS claims database (January 2014-June 2021, ~ 3.5 million insured). Baseline characteristics were observed within 12 months before index. Patient follow-up lasted ≥ 24 months or until death. Non-persistence (gap of ≥ 180 days) was calculated using Kaplan-Meier estimation. Cox regression identified variables linked to non- persistence. The study analysed reimbursed anti-VEGF treatments, thus excluding off-label use of bevacizumab.</p><p><strong>Results: </strong>5,498 patients diagnosed with nAMD (mean age, 80.09 years; male, 37.50%; mean Charlson Comorbidity Index [CCI] score, 3.07) and 484 patients with DR/DME (mean age, 67.14; male, 58.88%; mean CCI score, 4.54) were identified. Non-persistence to anti-VEGF treatment within 12 months after index occurred in 51.38% of nAMD patients and 62.60% of DR/DME patients, with mean times to first gap of 11.28 and 8.98 months, respectively. Cox regression revealed factors associated with non-persistence, including higher age, female gender, higher care needs, longer AMD history, and the use of ranibizumab.</p><p><strong>Conclusion: </strong>Epidemiologic and ophthalmologic factors associated with anti-VEGF non-persistence were successfully identified in the first year of therapy. The analyzed dataset can potentially be enriched with additional health insurance database sets under the used criteria to gain more understanding of anti-VEGF non-persistence.</p>\",\"PeriodicalId\":12795,\"journal\":{\"name\":\"Graefe’s Archive for Clinical and Experimental Ophthalmology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2024-11-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Graefe’s Archive for Clinical and Experimental Ophthalmology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00417-024-06690-9\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"OPHTHALMOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Graefe’s Archive for Clinical and Experimental Ophthalmology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00417-024-06690-9","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
Real-world therapy and persistence of patients with neovascular age-related macular degeneration and diabetic retinopathy or diabetic macular edema: a German claims data analysis.
Purpose: Vascular endothelial growth factor (VEGF) inhibition is the current and high-volume standard-of-care for patients with neovascular age-related macular degeneration (nAMD) and diabetic retinopathy (DR) with diabetic macular edema (DME). This study assessed the impact of non-persistence in anti-VEGF treatment using claims data from two German states.
Methods: This study identified adults with nAMD or DR/DME and incident anti-VEGF treatment (= index) in January 2015-June 2019 using the German AOK PLUS claims database (January 2014-June 2021, ~ 3.5 million insured). Baseline characteristics were observed within 12 months before index. Patient follow-up lasted ≥ 24 months or until death. Non-persistence (gap of ≥ 180 days) was calculated using Kaplan-Meier estimation. Cox regression identified variables linked to non- persistence. The study analysed reimbursed anti-VEGF treatments, thus excluding off-label use of bevacizumab.
Results: 5,498 patients diagnosed with nAMD (mean age, 80.09 years; male, 37.50%; mean Charlson Comorbidity Index [CCI] score, 3.07) and 484 patients with DR/DME (mean age, 67.14; male, 58.88%; mean CCI score, 4.54) were identified. Non-persistence to anti-VEGF treatment within 12 months after index occurred in 51.38% of nAMD patients and 62.60% of DR/DME patients, with mean times to first gap of 11.28 and 8.98 months, respectively. Cox regression revealed factors associated with non-persistence, including higher age, female gender, higher care needs, longer AMD history, and the use of ranibizumab.
Conclusion: Epidemiologic and ophthalmologic factors associated with anti-VEGF non-persistence were successfully identified in the first year of therapy. The analyzed dataset can potentially be enriched with additional health insurance database sets under the used criteria to gain more understanding of anti-VEGF non-persistence.
期刊介绍：
Graefe''s Archive for Clinical and Experimental Ophthalmology is a distinguished international journal that presents original clinical reports and clini-cally relevant experimental studies. Founded in 1854 by Albrecht von Graefe to serve as a source of useful clinical information and a stimulus for discussion, the journal has published articles by leading ophthalmologists and vision research scientists for more than a century. With peer review by an international Editorial Board and prompt English-language publication, Graefe''s Archive provides rapid dissemination of clinical and clinically related experimental information.
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