Optimising Wet-AMD Care: Real-world data on anti-VEGF injection frequency in South-West London (SWL) (2025)

South West London Integrated Care Board

Project summary

The aim of this project was to optimise anti-VEGF treatments for wet-AMD by analysing real-world data generated from the uniquely programmed SWL high-cost drug (HCD) data platform (Blueteq®). The goal of the analysis was to inform local treatment pathways and contribute to national wet-AMD pathway discussions on cost-effective and clinically effective treatments.

Using advanced reporting functionality integrated into HCD initiation and continuation forms, the data was extracted, exported and then graphically presented showing injection frequency of anti-VEGF treatments, categorised by treatment year and hospital Trust.

The data showed significant overlap in injection frequency between all anti-VEGF drugs. In the first treatment year, the distribution of injection frequency was similar across all anti-VEGF agents. In the second and subsequent years ranibizumab biosimilar and aflibercept had similar injection frequencies, with most patients needing 4 or 5 injections. A few patients on aflibercept required only 1 or 2 injections. Faricimab, used as a 2nd or 3rd choice agent, required the most injections (peaking at 6-8 injections/year).

The SWL wet-AMD pathway (which will be aligned with the recently published national pathway) recommends ranibizumab biosimilar as a 1st choice treatment option, with aflibercept or faricimab reserved as 2nd choice options. Patients may switch if there is a suboptimal response after 3 loading doses, a diminishing response in long-term users, if frequent injections are required to maintain disease stability, or due to side effects. In practice, most patients start on ranibizumab biosimilar or aflibercept, with faricimab used if treatment is suboptimal.

The higher injection frequency seen with faricimab is therefore likely because it is used in anti-VEGF treatment resistant patients, who had suboptimal response to previous anti-VEGF treatment.

The findings provide insights for optimising treatment protocols and ensuring efficient patient care. Treatments requiring fewer injections will result in fewer appointments for patients, improving convenience and minimises administration. This real-world data shows that selecting ranibizumab biosimilar or aflibercept results in comparable injection frequency.

Ranibizumab biosimilar is currently the most cost-effective anti-VEGF treatment and similar savings are expected from anticipated aflibercept biosimilar. By prioritising biosimilar versions of ranibizumab and aflibercept, significant cost savings can be achieved, contributing to more efficient use of healthcare resources.

This project has provided real world data on anti-VEGF injection frequency for wet-AMD. The data will inform local the treatment pathway and has helped inform national guidelines. By prioritising cost and clinically-effective treatments, it is possible to optimise patient outcomes while delivering substantial cost savings which can be reinvested in the NHS. This project demonstrates enhanced productivity, value for money whilst aiming to deliver excellence in patient care.