OBJECTIVES. To evaluate prescription patterns of anti-vascular endothelial growth factor(VEGF) drugs and healthcare costs among patients with diabetic macular edema(DME), diabetic retinopathy(DR), proliferative diabetic retinopathy(PDR), retinal vein occlusion(RVO), myopic choroidal neovascularization(mCNV).

METHODS. Retrospective study based on Italian administrative databases of 2 regions and 3 Local Health Units (sample population around 6million). During 01/01/2010—31/12/2017, patients ≥50 years old were included if they were prescribed anti-VEGF drugs (aflibercept, pegaptanib, ranibizumab) and/or had either diagnosis for DME, DR, PDR, RVO, mCNV or presence of injections of vitreous substitute with concomitant diabetes diagnosis or concomitant dexamethasone intravitreal implant. Patients diagnosed wet age-related macular degeneration were excluded. Patients were followed-up from index-date (first match with inclusion criteria) to 31/12/2018. Data involving ≤3patients were omitted for privacy.

RESULTS. According to preliminary results, 1,414 patients were included (mean age 70.0±9.4, 56.4% male). Most populated age-groups were 70-79 (36.7%) and 60-69 (31.2%); 16.6% of patients were ≥80 years old, 15.5% in age-group 50-59. During follow-up (mean 4.2±2.2years), 21.6% of patients died. Of patients included, 859 were diagnosed with ophthalmic diseases: 426(30,1%) DR, 270(19.1%) PDR, 106(7.5%) RVO, 41(2.9%) DME, 16(1.1%) mCNV. 680 patients received anti-VEGF drugs: 16.9% aflibercept and 82.9% ranibizumab. Mean number of anti-VEGF drugs prescription decreased during follow-up: 3.9±1.9 during 1^styear, 0.7±1.5 during 2^ndyear, 0.5±1.2 for 3^rdyear. With the same declining trend, mean number of aflibercept and ranibizumab prescriptions was 3.7±1.9 and 3.2±1.9 (1^styear), 0.8±1.6 and 0.7±1.4 (2^ndyear), 0.2±0.6 and 0.5±1.2 (3^rdyear), respectively. Mean healthcare costs for 1^styear of follow-up were €7,482.39 among aflibercept-users (of which €4,041.45 treatment-related) and €7,445.85 (of which €4,038.47 treatment-related) among ranibizumab-users. Considering patients prescribed anti-VEGF drugs, 56.5% of treatment costs were for anti-VEGF drugs.

CONCLUSIONS. This real-world study highlighted a decrease of anti-VEGF drugs prescriptions during follow-up. Our findings could indicate an inappropriate prescribing tendency that could increase the overall burden of ophthalmic diseases.