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Original Investigation | Clinical Sciences

The Effects of Technological Advances on Outcomes for Elderly Persons With Exudative Age-related Macular Degeneration

Frank A. Sloan, PhD1; Brian W. Hanrahan, MA1
[+] Author Affiliations
1Department of Economics, Duke University, Durham, North Carolina
JAMA Ophthalmol. 2014;132(4):456-463. doi:10.1001/jamaophthalmol.2013.7647.
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Importance  Exudative age-related macular degeneration (ARMD) is the major cause of blindness among US elderly. Developing effective therapies for this disease has been difficult.

Objectives  To assess the effects of introducing new therapies for treating exudative ARMD on vision of the affected population and other outcomes among Medicare beneficiaries newly diagnosed as having ARMD.

Design  The study used data from a 5% sample of Medicare claims and enrollment data with a combination of a regression discontinuity design and propensity score matching to assess the effects on the introduction or receipt of new technologies on study outcomes during a 2-year follow-up period.

Setting and Participants  The analysis was based on longitudinal data for the United States, January 1, 1994, to December 31, 2011, for Medicare beneficiaries with fee-for-service coverage. The sample was limited to beneficiaries 68 years or older newly diagnosed as having exudative ARMD as indicated by beneficiaries having no claims with this diagnosis in a 3-year look-back period.

Exposures  The comparisons with vision outcomes were after vs before the introduction of photodynamic therapy and anti–vascular endothelial growth factor (VEGF) therapy. The comparisons for depression and long-term care facility admission were between beneficiaries newly diagnosed as having exudative ARMD who received photodynamic therapy or anti-VEGF therapy compared with beneficiaries having the diagnosis who received no therapy for this disease.

Main Outcomes and Measures  Onset of decrease in vision, vision loss or blindness, depression, and admission to a long-term care facility.

Results  Among beneficiaries newly diagnosed as having exudative ARMD, the introduction of anti-VEGF therapy reduced vision loss by 41% (95% CI, 52%-68%) and onset of severe vision loss and blindness by 46% (95% CI, 47%-63%). Such beneficiaries who received anti-VEGF therapy and were not admitted to a long-term care facility during the look-back period were 19% (95% CI, 72%-91%) less likely on average to be admitted to a long-term care facility during the follow-up period.

Conclusions and Relevance  This study demonstrates gains in population vision from the introduction of anti-VEGF therapy for patients 68 years or older with an exudative ARMD diagnosis in community-based settings in the United States.

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