Age related macular degeneration; direct medical cost of management considering gained and/or saved vision

Purpose: The aim of this study is to quantitate the direct medical cost of wet age-related macular degeneration (AMD) versus gained or saved vision. Material and Methods: Clinical data of patients with wet AMD from Jan 2009 to Jan 2014 were reviewed retrospectively. Patients with a complete follow-up for two years, treated with only intravitreal ranibizumab injections and with no intraocular surgery during this period were included to this study. Demographics, diagnostic investigations, number of visits and injections, changes in visual acuity (VA) at one year and two years from baseline were noted. Detailed information for the unit costs of diagnostic procedures, injections, re-examinations, and paid price of ranibizumab were obtained from the Turkish Social Security Institution. Total cost for "year one" and "year two" were calculated, and the value of improving or saving the present vision was determined with subgroup analysis. Results: Two-hundred eyes of 175 patients were included into this study. There were 86 male and 89 female patients with a mean age of 72.3±7.8. The mean visual acuity was 0.292 (logMAR 0.67) at initial, 0.338 (logMAR 0.60) at the end of first year, 0.299 (logMAR 0.67) at the end of second year. The VA increased in 82 eyes, decreased in 76 eyes and remain stable in 42 eyes during the study. The mean visit numbers in "year one" and "year two" were 6.56 (3-12) and 5.74 (3-10), respectively. Average 4.42 (1-8) injections were performed in the first year and 2.25 (0-7) in the second. Total direct medical cost for AMD was 9.628,13 TL per patient for two years, which consisted of visit costs 529,11 TL, fluorescein and indocyanine angiography costs 115,33 TL, injection procedure costs 611,84 TL, and drug (ranibizumab 0.5 mg injectable solution) costs 8.371,84 TL. The cost of one gained line of visual acuity was 11.911 TL in the first year, while this could not be calculated for the second year because of the decrease in mean visual acuity. Conclusion: AMD is one of the leading causes of blindness among elderly people, and direct, indirect medical costs and nonmedical costs spent for these patients increase seriously. High volume of the patients expand the total budget for the disease and makes the value based medicine important. Overall results and subroup analysis of this study showed that treatment increased or stabilized the vision in reasonable amount of patients, the cost of management decreases in second year, the drug expenses are the leading item in reimbursement. Key words: Age related macular degeneration, direct medikal costs, QALY