Patient Preferences Associated with Anti-Vascular Endothelial Growth Factor Therapies for Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema
Received 24 July 2020
Accepted for publication 14 September 2020
Published 1 October 2020 Volume 2020:14 Pages 2975—2982
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Scott Fraser
Davis Bhagat,1 Breanne Kirby,1 Harit Bhatt,1,2 Rama Jager,1,2 Meena George,1,2 Veeral Sheth1,2
1University Retina and Macula Associates, Oak Forest, IL, USA; 2University of Illinois, Chicago, IL, USA
Correspondence: Veeral Sheth
University Retina and Macula Associates, 15947 W 127th St Suite E, Lemont, IL 60439, USA
Tel/Fax +1 630 410 8357
Purpose: To evaluate treatment-related preferences among patients receiving intravitreal anti-vascular endothelial growth factor (VEGF) therapy for neovascular age-related macular degeneration (nAMD) or diabetic macular edema (DME).
Patients and Methods: We conducted a prospective survey of patients with nAMD or DME treated at one of three US-based retina clinics. Prior to survey development, small focus groups with anti-VEGF-treated patients identified five treatment-related “attributes” considered important to those with nAMD or DME: vision outcomes, cost to the insurance provider, cost to the patient, frequency of treatment, and drug label status. Attributes were described using two to three “levels”, and hypothetical treatment profiles were generated by assigning one level to each attribute. Surveyed patients were asked to indicate their preference between two given treatment profiles for a total of eight pairwise comparisons. Discrete choice conjoint analysis was performed to estimate the relative importance of each attribute for the overall patient cohort, and for subgroups stratified by age and highest education level.
Results: Among 300 respondents, 54% were female, 78% were aged ≥ 65 years, and 67% indicated that high school was their highest level of education. Achieving good vision was the most important factor associated with anti-VEGF therapy for nAMD or DME (relative importance, 40.4%), followed by low cost to the patient, on-label drug status, less frequent treatment intervals, and low cost to the insurance provider (23.1%, 21.3%, 12.2%, and 3.0%, respectively). When patients were stratified by age group or highest education level, preference trends across subgroups were generally comparable with the overall cohort.
Conclusion: Our data suggest that treatment decisions regarding anti-VEGF therapies for nAMD or DME are most likely driven by their efficacy, and that patients may be willing to accept less desirable treatment attributes, such as increased cost and/or injection frequency, in order to achieve superior vision outcomes.
Keywords: anti-VEGF therapy, conjoint analysis, diabetic macular edema, neovascular age-related macular degeneration, patient preferences
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