Abstract
Purpose
This study aimed to compare persistence between patients prescribed intravitreal aflibercept (IVT-AFL) for neovascular age-related macular degeneration (nAMD) in Australia enrolled on a patient support program (PSP) with that of a sample of patients from the Australian Pharmaceutical Benefits Scheme (PBS) dataset (10% PBS sample); explore predictors of persistence; describe changes in patient beliefs over the course of their enrollment in a PSP for patients treated with IVT-AFL for nAMD; and assess patient satisfaction.
Participants and Methods
Participants prescribed IVT-AFL for the treatment of nAMD were invited to participate in the PSP. The PSP provided tailored support to patients through provision of a welcome pack, structured telephone calls, and information booklets. Persistence was defined in the PSP as the time from the start date in the program, until discontinuation from the program; and as the time from initial prescription until 6-months after the date of last prescription in the 10% PBS set. Persistence on the program and risk of discontinuation were modeled using Kaplan-Meier methods and Cox proportional hazards. In addition, persistence was compared between patients on the PSP and a 10% PBS sample of patients prescribed IVT-AFL for nAMD.
Results
Persistence on treatment at 24 months was significantly higher in patients enrolled on the PSP compared to the PBS cohort (88% vs 64%, p<0.05). The risk of discontinuation in patients enrolled on the PSP was higher in patients identified at screening as “high-risk”, those who were younger, or those with significant distance to travel for treatment. During the PSP, patients reported significant increase in their belief that they had control over their condition (6.1 ± 3.5 to 6.8 ± 3.7; p=0.0034) and a reduction in concerns about treatment. Satisfaction with the PSP was high.
Conclusion
Patients provided with access to a PSP showed better persistence on treatment and improved beliefs about nAMD disease and its treatment compared to those in the PBS sample. Improved persistence rates may translate into better outcomes for the patient and the healthcare system, however, further research is required to determine which elements of the program are most beneficial, particularly to those at high risk of discontinuation.
Acknowledgments
The authors thank Eric Chung from Prospection Pty Ltd for performing an earlier data analysis that prompted this research, Matthew Tucker from Atlantis Healthcare (Australia) Pty Ltd for performing PSP and PBS 10% data analysis, and Rachelle Steele, BPharm (Hons), and Belinda Butcher, BSc (Hons), MBiostat, PhD, CMPP, of WriteSource Medical Pty Ltd, Sydney, NSW, Australia, for providing medical writing support (funded by Bayer Australia Pty Ltd, Pymble, NSW, Australia, in accordance with Good Publication Practice guidelines). The authors thank Dawn Lobban at Envision Pharma Group for support in preparing the plain language summary of this paper (funded by Bayer Consumer Care AG, Basel, Switzerland). This study was funded by Bayer Australia Ltd.
Disclosure
AC reports consulting fees from Allergan, Novartis, Bayer, and Alcon, and involvement in clinical trials with Allergan, Novartis, Bayer, Alcon, Ophthotech, Opthea, Ionis, Oncobiologics, and Biofirst. JS reports no conflicts of interest. LP and CH are employees of Atlantis Healthcare (Australia) Pty Ltd who designed and delivered the SmartSight program. Bayer commissioned and sponsored the SmartSight program. PS is an employee of Bayer Australia Ltd, who manufacture Eylea (IVT-AFL). The authors report no other conflicts of interest in this work.