Malmberg C, Hjelmgren J

Färre injektioner, lägre kostnader för patient, sjukvård och samhälle? En ekonomisk analys av intravitreala injektioner i våt åldersrelaterad Makuladegeneration

The report is written in Swedish with a summary in English

New IHE report on the impact of injection frequency

Chronic diseases are often associated with frequent healthcare visits that affect patients, healthcare and society in various ways, for example through the use of healthcare resources or patient fees. At the same time, Swedish healthcare is facing challenges in the form of both staff shortages and waiting times. One possible way to address these challenges, according to the Swedish National Audit Office, is to make healthcare more efficient.
The purpose of this study was to analyse the economic impact of administration frequency on patients, healthcare and society. The analysis was conducted using wet age-related macular degeneration (AMD) as an example.

AMD is a chronic eye disease and the most common cause of visual impairment in the elderly. Wet AMD, which accounts for approximately 15% of cases, is treated with anti-VEGF drugs via intravitreal injections. The most common treatment regimen in Sweden is the so-called treat-and-extent (T&E) regimen, which means that the interval between injections is increased or decreased based on how the patient responds to the treatment.

In this study, the number of injections measured in the clinical trials of anti-VEGF drugs was compared with the number of injections from the Swedish Macula Register (SMR). The comparison included the drugs most commonly used in Sweden based on registry data and was made over a 5-year time horizon. Costs and time spent related to drug administration were compared. The analysis was conducted from a patient, healthcare and societal perspective.

The results show that the costs and time spent in all three perspectives are higher in the scenario based on the number of injections from Swedish clinical practice compared to that based on clinical trials. Costs related to administration accounted for the largest cost item, followed by outpatient visits. In terms of time spent, patients and their relatives stood for the largest proportion of time.

The analysis suggests that there is potential within Swedish clinical practice to reduce the number of injections, which could reduce costs and free up healthcare staff time for other care interventions. An additional analysis showed that costs and time in Swedish clinical practice could be reduced by 20% if treatment was conducted predominantly with newer anti-VEGFs compared to older anti-VEGFS.

In summary, the calculations in this report show that there is potential for savings in terms of costs and time in the treatment of wet AMD. Given a growing and aging population and an increasing need for specialized outpatient care, it is becoming increasingly important to use the available resources in healthcare in a more efficient way.

IHE RAPPORT 2025:8, IHE: Lund, Sweden