“With the current management model” of senile maculopathy (AMD, from the English Age-related macular degeneration), “the economic burden (impact, Ed.) associated with the individual patient is 60 thousand euros, of which the social costs weigh 60% (40 thousand euros). Pharmacological treatment weighs less than 17%. If we optimize the therapeutic path with technologies capable of facilitating adherence, the expenditure drops to 36,000 euros due to the reduction of the social one. The saving is almost 24,000 euros per patient”, over a long-term horizon (life-time). This was stated by Americo Cicchetti, director of Altems, the High School of Economics and Management of Health Systems – Faculty of Economics on the Rome campus of the Catholic University, presenting the results of a survey conducted with the unconditional support of Roche Italia during the online workshop ‘Age-related macular degeneration, emerging needs and crucial health policies for value-based care’.
The study conducted by Altems made it possible to quantify the economic impact of the management of patients with senile macular degeneration on the NHS and on society as a whole, but also to identify the points on which to leverage to ensure better management of these patients . Age-related macular degeneration – reads a joint note from Altems and Roche – is among the top 5 causes of blindness in industrialized countries for people over the age of 65 and involves a significant decrease in vision. For this reason it has a major impact on the quality of life of these patients, who are no longer able to carry out essential and secondary daily activities. In Italy, the advanced form, so-called “neovascular” (nAMD), mainly affects age groups (65-69 years and over 85) in which people are already frail, because they have a high rate of comorbidities including hypertension, dyslipidemia and diabetes.
nAmd is characterized by rapid vision loss, the damage of which does not reverse. The only solution currently available is represented by intravitreal injections with antagonistic treatments of the vascular endothelial growth factor (anti-Vegf) which allow to obtain a strong slowdown of the progression of the disease. However, these treatments are effective only if administered in a stable and continuous manner over time. However, to date, according to estimates, many patients do not show up for follow-ups, above all for fear of injections and because of frequent visits. Lack of adherence to therapies has an economic but also a social burden, for the patient and for the entire system.
According to the survey conducted by Altems, in current Italian clinical practice the economic burden for each individual patient affected by nAmd, over a life-time horizon, is equal to 60,017.94 euros. The greater expenditure of resources is associated with social costs, which represent 67.83% of the expenditure and, in part, also with pharmacological treatment (16.58% of the total). In addition to the cost, the survey also takes into account the time taken by the patient and by the caregiver for each single therapeutic episode: at least 5 hours for each single injection.
In a situation of optimal care of the patient with nAmd, based on a better adherence to pharmacological therapies, the total estimated expenditure drastically decreases to 36,068 euros with a saving of resources of almost 24 thousand euros on a lifetime estimate, per capita. The survey, thus making a comparison between the current scenario and the optimal one, clearly shows how a better care of the patient would allow a saving of resources, mainly reducing social costs. From the social security point of view, “we notice a scarce recourse to the population’s welfare services”, confirms in his speech Roberto Muscatello, National Institute of Social Security (INPS). “People who request services – he observes – show up with less and less serious maculopathy, which confirms the effectiveness of the therapies and the lower outlay for the indemnity”.
In conclusion, a better response and adherence to therapies on the part of the patient translates, in concrete terms, into the reduction of the pension and accompanying benefits, which are now recognized for patients with low vision or with reduced visual ability. This savings, calculated over a life-time horizon, would compensate for the increase in costs relating to pharmacological expenditure, administration of the therapy and long-term follow-up of the patient. Furthermore, the patient would be monitored more appropriately, thus reducing the rate of treatment abandonment.
