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Diffusion of anti-VEGF injections in the Portuguese National Health System.

Marques AP, Macedo AF, Perelman J, Aguiar P, Rocha-Sousa A, Santana R - BMJ Open (2015)

Bottom Line: The availability of an ophthalmology department in the county increased the rates of hospital episodes by 243%, and a 100-persons greater density per km(2) raised the rates by 11%.Our study shows a large but unequal diffusion of anti-VEGF treatments despite the universal coverage and very low copayments.The technological innovation in ophthalmology may thus produce unexpected inequalities related to financial constraints unless the implementation of innovative techniques is planned and regulated.

View Article: PubMed Central - PubMed

Affiliation: Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal.

No MeSH data available.


Related in: MedlinePlus

Number of hospital episodes associated with the top five diagnoses by year.
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BMJOPEN2015009006F2: Number of hospital episodes associated with the top five diagnoses by year.

Mentions: We used an administrative database that includes demographic, administrative and clinical information from all inpatient and day case episodes performed at all Portuguese NHS hospitals during the years 2002–2012. Authorisation to use these information was obtained by the Institutional Review Board (IRB) from Escola Nacional de Saúde Pública/Universidade Nova de Lisboa. In order to select the episodes related to intravitreal injections for anti-VEGF treatments, we used the following International Classification of Diseases 9th revision, Clinical Modification (ICD-9-CM) codes for procedures: 1474, 1475, 1479, 149. These codes have been commonly used in the literature but they are likely to capture other treatments such as injectable antibiotics or corticosteroids.1 Cases were excluded even if the diagnosis was likely to be associated with anti-VEGF treatment but the code of procedure was outside the selected group specified above. For example, for the five diagnoses shown in figure 2, there were 13 750 cases excluded from further analysis due to this filter. Effects to our estimation caused by the poor specificity of the code were reduced using two methods: (1) years 2002–2006 were included as baseline as before 2006 intravitreal anti-VEGF treatments for ophthalmological use were not licensed; and (2) we crossed information of age with principal diagnosis. Baseline years provide the picture of the number of cases associated with the codes but not related with anti-VEGF treatments. We considered that AMD only affects people in the age range 50–59 years or above,26 and anti-VEGF are used for specific diagnosis such as AMD or diabetic macular oedema. Online supplementary tables S1 and S2 show how this information was used in our methods. For the period studied, the only approved anti-VEGF drugs for use in public hospitals were Ranibizumab (Lucentis, Novartis) and Bevacizumab (Avastin).


Diffusion of anti-VEGF injections in the Portuguese National Health System.

Marques AP, Macedo AF, Perelman J, Aguiar P, Rocha-Sousa A, Santana R - BMJ Open (2015)

Number of hospital episodes associated with the top five diagnoses by year.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663428&req=5

BMJOPEN2015009006F2: Number of hospital episodes associated with the top five diagnoses by year.
Mentions: We used an administrative database that includes demographic, administrative and clinical information from all inpatient and day case episodes performed at all Portuguese NHS hospitals during the years 2002–2012. Authorisation to use these information was obtained by the Institutional Review Board (IRB) from Escola Nacional de Saúde Pública/Universidade Nova de Lisboa. In order to select the episodes related to intravitreal injections for anti-VEGF treatments, we used the following International Classification of Diseases 9th revision, Clinical Modification (ICD-9-CM) codes for procedures: 1474, 1475, 1479, 149. These codes have been commonly used in the literature but they are likely to capture other treatments such as injectable antibiotics or corticosteroids.1 Cases were excluded even if the diagnosis was likely to be associated with anti-VEGF treatment but the code of procedure was outside the selected group specified above. For example, for the five diagnoses shown in figure 2, there were 13 750 cases excluded from further analysis due to this filter. Effects to our estimation caused by the poor specificity of the code were reduced using two methods: (1) years 2002–2006 were included as baseline as before 2006 intravitreal anti-VEGF treatments for ophthalmological use were not licensed; and (2) we crossed information of age with principal diagnosis. Baseline years provide the picture of the number of cases associated with the codes but not related with anti-VEGF treatments. We considered that AMD only affects people in the age range 50–59 years or above,26 and anti-VEGF are used for specific diagnosis such as AMD or diabetic macular oedema. Online supplementary tables S1 and S2 show how this information was used in our methods. For the period studied, the only approved anti-VEGF drugs for use in public hospitals were Ranibizumab (Lucentis, Novartis) and Bevacizumab (Avastin).

Bottom Line: The availability of an ophthalmology department in the county increased the rates of hospital episodes by 243%, and a 100-persons greater density per km(2) raised the rates by 11%.Our study shows a large but unequal diffusion of anti-VEGF treatments despite the universal coverage and very low copayments.The technological innovation in ophthalmology may thus produce unexpected inequalities related to financial constraints unless the implementation of innovative techniques is planned and regulated.

View Article: PubMed Central - PubMed

Affiliation: Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal.

No MeSH data available.


Related in: MedlinePlus