Impact of a Patient Support Program on Patient Beliefs About Neovascular Age-Related Macular Degeneration and Persistence to Anti-Vascular Endothelial Growth Factor Therapy

Andrew Chang,1 John Stokes,2,3 Lindy Priestman,4 Connor Holmes,4 Peter Said5 1Sydney Retina Clinic, Sydney Institute of Vision Science, Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia; 2Inservio, Sydney, New South Wales, Australia; 3Department of Biomedical Sciences, Charles Sturt University, Orange, New South Wales, Australia; 4Atlantis Healthcare Pty Ltd, Sydney, New South Wales, Australia; 5Medical Affairs, Bayer Australia Ltd, Sydney, New South Wales, AustraliaCorrespondence: Andrew ChangSydney Retina Clinic, 187 Macquarie Street, Sydney, New South Wales, 2000, AustraliaTel + 61 2 92213755Fax + 61 2 92211637Email achang@sydneyretina.com.auPurpose: 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 and Methods: 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.Results: 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.Conclusion: 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.Keywords: intravitreal aflibercept, patient satisfaction, illness perceptions, medication beliefs, neovascular macular degeneration, persistence