Impact of out-of-pocket costs on patient initiation, adherence and persistence rates for patients treated with anti-vascular endothelial growth factor medicines

Importance: Out-of-pocket costs are a key driver of patient decisions to access, adhere and persist with anti-vascular endothelial growth factor (VEGF) therapy. The Medicare Benefits Schedule Review Taskforce proposes a 69% reduction in the scheduled fee for intravitreal injections (item 42 738) which risks increasing out-of-pocket costs for patients and worsening visual outcomes.

Background: To determine the impact of out-of-pocket costs on current anti-VEGF utilization rates in patients with neovascular age-related macular degeneration (nAMD) and diabetic macular oedema (DMO).

Design: This is a retrospective cohort drug-utilization analysis.

Participants: This study involved 11 592 patients in Australia diagnosed with nAMD or DMO.

Methods: A retrospective analysis of electronic, de-identified dispensing records of patients diagnosed with nAMD or DMO who initiated anti-VEGF therapy between January 1, 2016 and December 2018 across Australia. Patients were categorized by treatment facility type: bulk-billing clinics (BBCs) and "rest of market" clinics (ROMCs).

Main outcome measures: Dispensing quantities, intervals and persistence rates.

Results: For patients with nAMD who initiated therapy between 2016 and 2018 the mean number of medicines dispensed up to September 30, 2019 was 17.0 for BBC and 13.8 for ROMC patients. For patients with DMO, the mean number of medicines dispensed was 16.5 for BBC patients and 12.5 for ROMC patients. Patients treated at BBCs had higher persistence rates than those treated at ROMCs. DMO patients had higher initiation rates BBCs (46%) vs ROMCs (25%).

Conclusions and relevance: Lower out-of-pocket costs are associated with higher adherence and persistence rates for anti-VEGF therapy in patients with AMD and DMO and higher initiation rates for DMO patients.