In the treatment of age-related macular degeneration (AMD), up to 24,000 euros could be saved per patient “alone” with better planning of taking charge by the national health system. The researchers of the Advanced School of Economics and Management of Health Systems (ALTEMS) of the Catholic University of Rome have done the math, according to which greater efficiency in the use of resources would also contribute to improving the quality of life of patients.
The disease and the treatments available
We are talking about a very widespread and progressive pathology, counted among the top five causes of blindness in industrialized countries for the over 65s. The cause is the malfunction or death of the cells of the retinal pigment epithelium, a fundamental structure for the proper functioning of our eye. The advanced form of this disease, called “neovascular” (nAMD), leads to rapid vision loss. The only solution available at the moment is represented by intravitreal injections with anti-VEGF drugs (antagonists of the vascular endothelial growth factor) which allow to obtain a strong slowdown of the progression of the disease. However, these treatments are effective only if administered in a stable and continuous manner over time.
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How the costs are distributed
According to the ALTEMS survey, over 60,000 euros are spent in Italy for each patient suffering from nAMD, of which only 16.58% goes to the actual pharmacological treatment, while social costs represent 67.83% of the expenditure. In an optimal management situation, based on a better adherence to pharmacological therapies, the research estimates a drastic decrease in overall expenditure up to around 36 thousand euros per person. One of the main problems, in fact, would be the poor adherence to therapies by patients, who often do not show up for follow-ups for fear of injections or because of the frequent visits they have to undergo. Better care would, in particular, allow for a reduction in social costs. Which, calculated over a life time horizon, would compensate for the increase in costs relating to pharmacological expenditure, administration of therapy and patient follow-up in the long term. “The research – explains Stanislao Rizzo, full professor of Visual Apparatus Diseases at the Catholic University, and Director of the Ophthalmology Complex Operational Unit of the IRCCS Fondazione Policlinico Universitario Agostino Gemelli – shows how an inappropriate care pathway not only involves economic inefficiencies, but contributes negatively to patient and caregiver quality of life and associated costs.
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The patient’s point of view
“Considering what emerged from the ALTEMS research and that almost all patients with maculopathy live with at least one further comorbidity, we believe it is essential to ensure the active participation of patients in the research and development of management models”, adds Assia Andrao, President of Retina Italy. The patient and his caregiver – underlines the association – are the only ones who can give a point of view on the pathology experienced firsthand.
4 ways to improve management
It is possible to identify, according to the report, at least 4 levers to improve taking charge. First of all, it is necessary to acquire awareness of the current situation of taking care of patients and the related economic and social impact, taking into account all the stakeholders involved. Based on this, it would then be appropriate to build a more integrated care, which reduces inequalities and favors the conditions of maximum appropriateness, such as the best adherence to care. Finally, it is important to know the economic return of these changes. “The report brings out clear needs linked to the economic and investment sphere – concludes Americo Cicchetti, full professor of Business Organization at the Catholic University and director of ALTEMS -. On the one hand, it is essential to promote an increasingly integrated strategic planning of investments between the health and social spheres, on the other, it is necessary to measure the impact of the health investment based on the value generated within the process of taking charge” .
