Chang Andrew, Stokes John, Priestman Lindy, Holmes Connor, Said Peter
Sydney Retina Clinic, Sydney Institute of Vision Science, Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia.
Inservio, Sydney, New South Wales, Australia.
Patient Prefer Adherence. 2021 Mar 3;15:511-521. doi: 10.2147/PPA.S293941. eCollection 2021.
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 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.
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.
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.
本研究旨在比较澳大利亚参加患者支持项目（PSP）的接受玻璃体内注射阿柏西普（IVT - AFL）治疗新生血管性年龄相关性黄斑变性（nAMD）的患者与澳大利亚药品福利计划（PBS）数据集中10%样本患者（PBS样本）的治疗持续性；探索持续性的预测因素；描述接受IVT - AFL治疗nAMD的患者在参加PSP过程中患者信念的变化；并评估患者满意度。
被处方IVT - AFL治疗nAMD的参与者受邀参加PSP。PSP通过提供欢迎礼包、结构化电话沟通和信息手册为患者提供量身定制的支持。在PSP中，持续性定义为从项目开始日期到退出项目的时间；在10%的PBS样本中，持续性定义为从初始处方到最后一次处方日期后6个月的时间。使用Kaplan - Meier方法和Cox比例风险模型对项目中的持续性和停药风险进行建模。此外，还比较了PSP中的患者与10%接受IVT - AFL治疗nAMD的PBS样本患者的持续性。
与PBS队列相比，参加PSP的患者在24个月时的治疗持续性显著更高（88%对64%，p<0.05）。在PSP中，筛查时被确定为“高风险”、年龄较小或前往治疗地点距离较远的患者停药风险更高。在PSP期间，患者报告称他们对自身病情的控制信念显著增强（从6.1±3.5提高到6.8±3.7；p = 0.0034），对治疗的担忧减少。对PSP的满意度较高。
与PBS样本中的患者相比，能够使用PSP的患者在治疗上表现出更好的持续性，并且对nAMD疾病及其治疗的信念有所改善。提高的持续性率可能会为患者和医疗系统带来更好的结果，然而，需要进一步研究以确定该项目的哪些要素最有益，特别是对那些有高停药风险的患者。
