Head to head comparison of the clinical and cost effectiveness of Observe and Plan versus PRN for the treatment of wet macular degeneration

Purpose: “Observe and Plan” (O&P) is a novel treatment regimen for neovascular AMD (nAMD). It aims to optimise the intravitreal anti-VEGF injection frequency whilst dramatically reducing the number of clinical reviews (compared to PRN/ treat and extend). However, there has been no head-to-head comparison of O&P versus the other regimens: We aim to establish whether O&P is non-inferior to PRN and whether there is an economic advantage. Methods: Prospective interventional cohort study: Patients undergoing treatment with PRN aflibercept for nAMD were enrolled. All were switched to O&P aflibercept for one year. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were recorded in addition to the number of clinic visits and intravitreal injections. Their results were compared in a paired analysis to their own data whilst on PRN treatment the preceding year. Results: 25 patients were enrolled. 17 completed one year of treatment, one of whom was subsequently excluded (confounding pathology). Analysis of area under the curve for BCVA and CMT found O&P to be non-inferior to PRN p=0.03, p<0.01. The mean number of clinical reviews was significantly reduced under O&P (1.80 (SD 0.68) vs. 8.66 (SD 0.72) visits per year; P=<0.01) with an improvement in injection to visit ratio (1.01 vs. 1.67 vists/injection), equating to an estimated saving of £1,228 per patient per year. Conclusion: The O&P regimen for treatment of nAMD was clinically non-inferior to PRN. The O&P regimen was superior to PRN in terms of reducing the health economic burden and treatment burden of nAMD.