A longitudinal study to assess the frequency and cost of anti-vascular endothelial therapy, and inequalities in access, in England between 2005 and 2015

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Abstract

Objectives: High cost anti-VEGF medicines for eye disorders challenge ophthalmologists and policymakers to provide fair access for patients while minimising costs. We describe the growth in the use and costs of these medicines and measure inequalities in access.

Design: Longitudinal study using hospital episode statistics (2005/6 to 2014/15) and hospital prescribing cost reports (2008/9 to 2015/16). We used Poisson regression to estimate standardised rates and explore temporal and geographic variations.

Setting: NHS care in England.

Population: Patients receiving anti-VEGF injections for age-related macular degeneration, diabetic macular oedema and other eye disorders.

Interventions: Higher cost drugs (ranibizumab or aflibercept) recommended by NICE or lower cost drug (bevacizumab) not licensed for eye disorders.

Main outcome measures: National procedure rates and variation between and within clinical commissioning groups (CCGs). Cost of ranibizumab and aflibercept prescribing.

Results: Injection procedures increased by 215% between 2010/11 and 2014/15. In 2014/15 there were 388,031 procedures (714 per 100,000). There is no evidence that the dramatic growth in rates is slowing down. Since 2010/11 the estimated cost of ranibizumab and aflibercept increased by 247% to £447 million in 2015/16, equivalent to the entire annual budget of a CCG. There are large inequalities in access; in 2014/15 procedure rates in a ‘high use’ CCG were 9.08 times higher than in a ‘low use’ CCG. In the South West of England there was twofold variation in injections per patient per year (range 2.9 to 5.9).

Conclusions: The high and rising cost of anti-VEGF therapy affects the ability of the NHS to provide care for other patients. Current regulations encourage the increasing use of ranibizumab and aflibercept rather than bevacizumab, which evidence suggests is more cost-effective. NHS patients in England do not have equal access to the most cost-effective care.
Original languageEnglish
Article numbere018289
Number of pages11
JournalBMJ Open
Volume7
Issue number10
Early online date22 Oct 2017
DOIs
Publication statusPublished - Oct 2017

Structured keywords

  • BTC (Bristol Trials Centre)
  • Centre for Surgical Research

Keywords

  • Vascular Endothelial Growth Factor A
  • Drug Costs
  • macular degeneration
  • macular edema
  • England
  • socioeconomic factors
  • geography

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