Real-world Study Of Age-related Macular Degeneration Based On Hospital Information Platform System

Purpose: Considering the high expenditure of anti-vascular endothelial growth factor(VEGF)medicine,long-term and often lifelong repeated injections required of neovascular age-related macular degeneration(nAMD)patients,the pressure on the retina specialists and hospitals,the economic burden on the healthcare system,it is important to understand the clinical patterns of AMD in the real-world settings.This study aims to use the data from the hospital information platform system,to conduct a real-world data analysis study on AMD patients in Shanghai-to describe the epidemiology and treatment rate of AMD,analyze the treatment status of nAMD patients receiving treatment,and preliminarily assess the medical expenditure on AMD.We hope it will provide a more comprehensive and unique perspective for patients,doctors and healthcare decision-makers in their understanding,diagnosis and treatment of AMD.Methods: This study adopted the data from the Shanghai Shenkang Hospital Development Center “Medical United Project" system platform.Data include the patient's basic information(name,gender,date of birth,medical card number and type),the date of clinical visits,the Optical Coherence Tomography(OCT),the intravitreal injection and anti-VEGF medicine payment records.The program written based on Python version 2.7 was used for the data analysis.SPSS 22.0 software was used for the statistical analysis.Results: In this study,a total of 37,654 patients diagnosed with "age-related macular degeneration" and/or "macular degeneration" from January 1,2013 to November 30,2017 were included.The mean age was 67.2±9.6 years,and the proportion of male patients was 42.4%.Among the 3584 nAMD patients treated with anti-VEGF,the mean number of injections in the first year was 2.3±1.6,and the mean number of clinical visits in the first year was 3.8±2.9.Only 12.6% of nAMD patients received 3LD treatment.Loss to follow-up(LTFU)rate of nAMD patients was 43.3%.Male nAMD patients were more likely to lose follow-up(adjusted OR =1.42,95% confidence interval: 1.24-1.64,P <0.001).The risk of LTFU for uninsured nAMD patients was nearly twice that for insured nAMD patients(adjusted OR =2.10,95% confidence interval: 1.82-2.42,P <0.001).Conclusion: This study mainly analyzed the treatment status of nAMD patients using data from real-world settings.Due attention should be paid to the low frequency of injections and clinic visits and the high rate of LTFU.In addition,male patients and uninsured patients were more likely to lose follow-up after treatment,which reminds the ophthalmologists to strengthen communication and education for patients with such a high risk of losing follow-up.Furthermore,it supports the healthcare decision-makers to include anti-VEGF medicine into the government medical insurance.