Abstract：
BACKGROUND: Age-related macular degeneration (AMD) is a disease that causes damage in the macular region of the retina, leading to irreversible blindness. This study aims to understand the profile and care of patients with AMD and its cost at the Brazilian public health system to identify AMD-care needs.
METHODS: This is a retrospective observational study of AMD with real-world data from the Brazilian public healthcare system, using DATASUS claim databases. Patients with AMD were selected from 01/Jan/2014 to 31/Jan/2020; had at least one claim of ICD10 code H35.3 (Degeneration of macula and posterior pole), and were submitted to one of two procedures exclusively available for AMD patients - optical coherence tomography (OCT) and medical treatment of retinal disease (antiangiogenic); aged ≥18 years at first ICD10 claim, and presenting at least 1 year of follow-up in the database. We described patients\' characteristics, healthcare resource utilization and cost, and the antiangiogenic intravitreal treatment received by AMD patients, including the number of doses and interval time between them.
RESULTS: Patients searching for AMD treatment since 2014 were mostly females (59%), white (61%), and a mean age of 72 years. They were mainly located in the Southeast (87%), and few patients were found in the North (1%) and Central-West (1.5%) regions, probably reflecting where the Brazilian guideline to treat AMD (Protocolo Clínico e Diretrizes Terapêuticas - PCDT) was incorporated as routine care for AMD. The average antiangiogenic dose of 2.5 antiangiogenic therapies within a year was below the expected. Most injections had an interval time of 20 to 40 days between doses, although some patients were treated more than 100 days. Another setback is that patients traveled longer distances for OCT and antiangiogenic treatment than overall AMD-healthcare, between 10 and 100 km.
CONCLUSIONS: AMD patients seem to be undertreated, as they receive a mean of 2.5 doses of antiangiogenic treatment within a year. Inequalities among regions are evident, as the Southeast and South regions comprise almost all patients receiving the treatment from the public health system, probably reflecting the region with more access to AMD care according to PCDT recommendations.
METHODS: This is a retrospective observational study of AMD with real-world data from the Brazilian public healthcare system, using DATASUS claim databases. Patients with AMD were selected from 01/Jan/2014 to 31/Jan/2020; had at least one claim of ICD10 code H35.3 (Degeneration of macula and posterior pole), and were submitted to one of two procedures exclusively available for AMD patients - optical coherence tomography (OCT) and medical treatment of retinal disease (antiangiogenic); aged ≥18 years at first ICD10 claim, and presenting at least 1 year of follow-up in the database. We described patients\' characteristics, healthcare resource utilization and cost, and the antiangiogenic intravitreal treatment received by AMD patients, including the number of doses and interval time between them.
RESULTS: Patients searching for AMD treatment since 2014 were mostly females (59%), white (61%), and a mean age of 72 years. They were mainly located in the Southeast (87%), and few patients were found in the North (1%) and Central-West (1.5%) regions, probably reflecting where the Brazilian guideline to treat AMD (Protocolo Clínico e Diretrizes Terapêuticas - PCDT) was incorporated as routine care for AMD. The average antiangiogenic dose of 2.5 antiangiogenic therapies within a year was below the expected. Most injections had an interval time of 20 to 40 days between doses, although some patients were treated more than 100 days. Another setback is that patients traveled longer distances for OCT and antiangiogenic treatment than overall AMD-healthcare, between 10 and 100 km.
CONCLUSIONS: AMD patients seem to be undertreated, as they receive a mean of 2.5 doses of antiangiogenic treatment within a year. Inequalities among regions are evident, as the Southeast and South regions comprise almost all patients receiving the treatment from the public health system, probably reflecting the region with more access to AMD care according to PCDT recommendations.
摘要：
背景：年龄相关性黄斑变性（AMD）是一种导致视网膜黄斑区损伤的疾病，导致不可逆转的失明。这项研究旨在了解AMD患者的概况和护理及其在巴西公共卫生系统中的成本，以确定AMD护理需求。
方法：这是一项针对AMD的回顾性观察研究，使用来自巴西公共医疗系统的实际数据，使用DATASUS索赔数据库。AMD患者的选择时间为2014年1月1日至2020年1月31日；至少有一次ICD10代码为H35.3（黄斑和后极变性），并提交了专门用于AMD患者的两个程序之一-光学相干断层扫描（OCT）和视网膜疾病的医学治疗（抗血管生成）；在第一次ICD10索赔时年龄≥18岁，并在数据库中提供至少1年的随访。我们描述了病人的特征，医疗资源利用率和成本，和AMD患者接受的抗血管生成玻璃体内治疗，包括剂量的数量和它们之间的间隔时间。
结果：自2014年以来寻求AMD治疗的患者大多是女性（59％），白色（61%），平均年龄72岁.他们主要位于东南部（87％），在北部（1％）和中西部（1.5％）地区发现的患者很少，可能反映了巴西的AMD治疗指南(ProtocoloClínicoeDiretrizesTerapäuticas-PCDT)被纳入AMD的常规治疗。一年内2.5种抗血管生成疗法的平均抗血管生成剂量低于预期。大多数注射之间的间隔时间为20至40天，虽然有些患者治疗超过100天。另一个挫折是，与总体AMD医疗保健相比，患者进行OCT和抗血管生成治疗的距离更长。在10到100公里之间。
结论：AMD患者似乎治疗不足，因为他们在一年内平均接受2.5剂量的抗血管生成治疗。地区之间的不平等是显而易见的，由于东南部和南部地区几乎包括所有接受公共卫生系统治疗的患者，根据PCDT的建议，这可能反映了该地区获得AMD治疗的机会更多。
方法：这是一项针对AMD的回顾性观察研究，使用来自巴西公共医疗系统的实际数据，使用DATASUS索赔数据库。AMD患者的选择时间为2014年1月1日至2020年1月31日；至少有一次ICD10代码为H35.3（黄斑和后极变性），并提交了专门用于AMD患者的两个程序之一-光学相干断层扫描（OCT）和视网膜疾病的医学治疗（抗血管生成）；在第一次ICD10索赔时年龄≥18岁，并在数据库中提供至少1年的随访。我们描述了病人的特征，医疗资源利用率和成本，和AMD患者接受的抗血管生成玻璃体内治疗，包括剂量的数量和它们之间的间隔时间。
结果：自2014年以来寻求AMD治疗的患者大多是女性（59％），白色（61%），平均年龄72岁.他们主要位于东南部（87％），在北部（1％）和中西部（1.5％）地区发现的患者很少，可能反映了巴西的AMD治疗指南(ProtocoloClínicoeDiretrizesTerapäuticas-PCDT)被纳入AMD的常规治疗。一年内2.5种抗血管生成疗法的平均抗血管生成剂量低于预期。大多数注射之间的间隔时间为20至40天，虽然有些患者治疗超过100天。另一个挫折是，与总体AMD医疗保健相比，患者进行OCT和抗血管生成治疗的距离更长。在10到100公里之间。
结论：AMD患者似乎治疗不足，因为他们在一年内平均接受2.5剂量的抗血管生成治疗。地区之间的不平等是显而易见的，由于东南部和南部地区几乎包括所有接受公共卫生系统治疗的患者，根据PCDT的建议，这可能反映了该地区获得AMD治疗的机会更多。
