Direct Treatment Costs of Neovascular Age-related Macular Degeneration and Comparison of Gained and/or Preserved Vision with Expenditure

Objectives: The aim was to quantify the direct medical cost of neovascular age-related macular degeneration (AMD) versus gained or preserved vision. Materials and Methods: Data of patients treated for neovascular AMD between January 2009 to January 2014 were reviewed. Patients with complete follow-up for two years, treated with only intravitreal ranibizumab injections and with no intraocular surgery were included. Demographics, diagnostic investigations, the number of visits and injections, changes in visual acuity (VA) at one year and two years from baseline were noted. Total cost was calculated for the first and second years, and the cost of improving or preserving initial vision level was determined with subgroup analysis. Results: Two-hundred eyes of 175 patients (86 male and 89 female) with a mean age of 72.3±7.8 years were included. Mean VA was 0.67 logMAR at baseline, 0.60 logMAR at the end of the first year, and 0.67 logMAR at the end of the second year. At the end of the 2 years, VA increased in 82 eyes (41%), remained the same in 42 eyes (21%), and decreased in 76 eyes (38%). The mean number of visits in the first and second years were 6.56 (3-12) and 5.74 (3-10), respectively. An average of 4.42 (1-8) injections were performed in the first year and 2.25 (0-7) in the second. The total direct medical cost for AMD was 9,628 TL (Turkish Lira) per patient for 2 years, which consisted of 529 TL in visit costs, 115 TL in fluorescein and indocyanine angiography costs, 611 TL in injection procedure costs, and 8,371 TL in drug costs. The cost of one line of VA gain was 11,911 TL in the first year. Conclusion: This study showed that treatment increased or stabilized vision in a reasonable proportion of patients, that cost of management decreases in the second year, and that drug expenses are the leading item in reimbursement