OCT for AMD Makes Healthcare More Affordable

Matthew Windsor, PhD

Investments into optical coherence tomography (OCT) research, particularly in association with its use as a guiding therapy for neovascular age-related macular degeneration (nAMD), have resulted in an estimated accrued savings of $9.0 billion for the US government through Medicare and an estimated $2.2 billion in savings for nAMD patients.

Matthew A. Windsor, PhD, Senior Manager of Science Communications, and colleagues at the Association for Research in Vision and Ophthalmology (ARVO) led this study on the economic impact of OCT for patients and research investors. Windsor and colleagues stated that the $9.0 billion "represents a 21-fold return on government investment" by the US National Institutes of Health (NIH) and National Science Foundation (NSF).

In order to perform their cost-analysis of the use of OCT, Windsor and colleagues developed an observational cohort study which included data from Medicare claim files for anti-vascular endothelial growth factor (anti-VEGF) drugs between 2013-2015. During the analysis, the researchers compared data on actual spending versus hypothetical spending if patients received solely fixed-regimen anti-VEGF therapies for nAMD, and then compared that information to OCT-related government investment and nAMD patient savings.

Windsor and colleagues discovered that under a fixed-regimen only therapy for nAMD patients would have spent $24.4 billion dollars on anti-VEGF drugs, but that the use of OTC-guided personalized treatment "enabled Medicare to save $10.3 billion on anti-VEGF therapy costs for nAMD from 2008-2015." Windsor comments that the reductions of ranibizumab injections alone, due to OCT-guided treatments, "are responsible for 83% of the calculated savings" reported.

Windsor claimed that treatment for nAMD can be expensive, and the use of FDA-approved monthly ranibizumab and bimonthly aflibercept (2 anti-VGEF agents), costs patients $24,000 and $12,000, respectively, per year.

Windsor and colleagues wrote that a third anti-VEGF drug, bevacizumab is more affordable, with average costs at approximately $70 per dose, therefore making it a popular nAMD treatment option. However, the use of bevacizumab is not FDA approved for treatment of nAMD.

Overall, Windsor and colleagues reported that the use of ranibizumab and aflibercept accounted "for more than 16% of Medicare Part B (drug) spending in 2013, at roughly $2.4 billion." The costs continue to rise as drug prices increase and the population ages, subsequently increasing the incidence of nAMD.

\Windsor and colleagues claimed that the use of OCT as a means to individualize and guide treatment of nAMD patients allows doctors to be more efficient, tailoring treatment to patients and thus lowering costs of the overall treatments. Before OCT became a routine part of nAMD treatment, though, “physicians were limited to following a fixed, FDA-approved treatment schedule for anti-VEGF drugs to treat nAMD.”

But with the use of OCT, ophthalmologists can better detect the levels of excess macular fluid in each patient and adjust the anti-VEGF therapy schedule based on the information the OCT provides. Wilson and colleagues stated that the use of OCT as a guiding for treatment has allowed for the development of treat-and-extend and as needed options for the treatment of nAMD, which helps curb unnecessary treatment and lower costs.

Using meta-analysis and survey data, Windsor and colleagues determined the cost of OCT imaging to guide anti-VEGF treatment decisions to be $0.8 billion between 2008-2015. They also determined that the NIH and NSF spent an approximate "$0.4 billion on basic and clinical research toward the development of OCT from 1995-2015."

Considering the costs and benefits, Wilson and colleagues determined that overall savings were $9.0 billion for the US government, which factored out to a remarkable 2100% return on OCT research investment. Cost-analysis of patient savings resulted in equally remarkable numbers. Windsor and colleagues report that "OCT has enabled nAMD patients to save over $2.2 billion by avoiding 17.7 million anti-VEGF injections from 2008-2015."

In a statment from ARVO, the corresponding author David Huang stated that the study provided "a rare example of being able to quantify the impact research can have, in this case via reduced healthcare spending," adding that he believes the study has "shown that return on research investment can be very high."

Although the article states that the analysis had several limitations which may have led to an over- or under-estimation of the exact savings, Windsor and colleagues believe that their analysis shows "that innovative technology can significantly reduce healthcare costs and improve patient care" that serve as counter-evidence to the belief that medical research is high-cost with little return on research investment. Windsor wrote that "we hope that highlighting the impact of OCT on patient health and public spending encourages further government investment in biomedical research—even in these budget-constrained times."

The study, "Estimating Public and Patient Savings From Basic Research—A Study of Optical Coherence Tomography in Managing Antiangiogenic Therapy" appeared in the American Journal of Ophthalmology.