Ranibizumab and aflibercept: analysis of use for AMD, DMO, BRVO and CRVO
Page last updated: 26 October 2018
Drug utilisation sub-committee (DUSC)
May 2018
Abstract
Purpose
To assess the utilisation of PBS listed medicines for age related macular degeneration (AMD), diabetic macular oedema (DMO), branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO).
Listing on the Pharmaceutical Benefits Scheme (PBS)
|
|
Abridged restriction |
Date listed |
|---|---|---|
|
Ranibizumab |
Subfoveal choroidal neovascularisation (CNV) due to age-related macular degeneration (AMD). |
1 August 2007 |
|
Aflibercept |
CNV due to AMD. |
1 December 2012 |
|
Ranibizumab |
Visual impairment due to macular oedema (MO) secondary to branch retinal vein occlusion (BVRO) and central retinal vein occlusion (CRVO). |
1 July 2015 |
|
Ranibizumab |
Visual impairment due to diabetic macular oedema (DMO). |
1 July 2015 |
|
Aflibercept |
Visual impairment due to DMO. |
1 October 2015 |
|
Aflibercept |
Visual impairment due to macular oedema secondary to CRVO. |
1 October 2015 |
|
Aflibercept |
Visual impairment due to macular oedema secondary to BRVO. |
1 December 2016 |
|
Dexamethasone implant |
Visual impairment due to DMO for patients unsuitable for, contraindicated to, or who have failed VEGF inhibitors. |
1 November 2016 |
Data Source / Methodology
Data were extracted from the Department of Human Services (DHS) Medicare Pharmacy Claims database for the period August 2007 to December 2017, inclusive.
Key Findings
- The overall use of ranibizumab and aflibercept increased following the listings of DMO and RVO, but the majority of use of ranibizumab and aflibercept is for AMD.
- Use of medicines for AMD continues to grow because of the ageing population and high rates of treatment continuation. In 2017 50,964 patients were treated for AMD. The mean age of patients initiating ranibizumab or aflibercept for AMD was 79 years.
- In 2017, 11,137 patients were treated for DMO with VEGF inhibitors. Use of medicines for DMO has been lower than expected because the number of treated patients and the number of injections per patient were overestimated. The mean age of patients initiating ranibizumab or aflibercept for DMO was 64 years.
- In 2017, 995 patients were supplied 2,197 dexamethasone implants for DMO. Dexamethasone implant is restricted to use in patients who are unsuitable for, contraindicated to, or who have failed VEGF inhibitors. About half of patients supplied dexamethasone in 2017 had previously received ranibizumab and/or aflibercept.
- In 2017, 10,781 patients were treated for RVO. Use of medicines for RVO is higher than expected because the number of treated patients and continuation rates were underestimated. The average number of injections per patient however has been lower than expected. The mean age of patients initiating ranibizumab or aflibercept for RVO was 73 years. Continuation rates and the number of injections per person are similar for BRVO and CRVO.
- A high proportion (39%) of patients commencing PBS subsidised treatment for RVO had previous or subsequent PBS prescriptions for AMD and/or DMO. This was not anticipated. It is possible that there may have been some use of ranibizumab or aflibercept for RVO outside of the restrictions before it was listed.
- The number of injections per patient is similar whether aflibercept or ranibizumab is used for AMD, DMO or RVO, consistent with the PBAC’s consideration that these medicines should be priced on an injection: injection basis.
- Consistent with the disease aetiology, the proportion of bilateral treatment is higher for DMO than for AMD, and very low in RVO. For DMO approximately 30% of prescriptions are supplied with a quantity of two indicating bilateral treatment. For AMD approximately 10% of prescriptions are supplied with a quantity of two.
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