ArticleBMJ open2017
A longitudinal study to assess the frequency and cost of antivascular endothelial therapy, and inequalities in access, in England between 2005 and 2015.
Article in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed, 1 synthesis or guideline pooled it, 47 citations in OpenAlex.
- Optical coherence tomography imaging biomarkers associated with neovascular age-related macular degeneration: a systematic review.Eye (London, England) · 2023Pooled it
- Beyond Cost: Faricimab as a Driver of Service Efficiency and Quality in Neovascular Age-Related Macular Degeneration Care.Ophthalmology and therapy · 2026Article
- Investigating the feasibility of selective anti-VEGF delivery to the retina using a microinvasive approach.Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2025Article
- Clinical and Socioeconomic Burden of Retinal Diseases: Can Biosimilars Add Value? A Narrative Review.Ophthalmology and therapy · 2025Review
- Greener intravitreal injections: a narrative review.Eye (London, England) · 2024Review
- An eye on equity: faricimab-driven health equity improvements in diabetic macular oedema using a distributional cost-effectiveness analysis from a UK societal perspective.Eye (London, England) · 2024Article
- Intravitreal bevacizumab plus propranolol for neovascular age-related macular degeneration (the BEVALOL study): a phase I clinical trial.International journal of retina and vitreous · 2023Article
- Novel Combined Lidocaine/Povidone Iodine Delivery System for Preintravitreal Injection.Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics · 2022Article
- Microvascular abnormalities and long-term efficacy after stereotactic radiotherapy under continued intravitreal anti-VEGF treatment for neovascular AMD.The British journal of ophthalmology · 2022Article
- Assessment of Anti-VEGFs in Treating Diabetic Macular Edema in Alfaisal Eye Center, Khartoum, Sudan, 2019.Clinical pharmacology : advances and applications · 2022Article
- Anti-VEGF and Other Novel Therapies for Neovascular Age-Related Macular Degeneration: An Update.BioDrugs : clinical immunotherapeutics, biopharmaceuticals and gene therapy · 2021Review
- Review
- Post-injection endophthalmitis rates with reduced povidone-iodine prophylaxis in patients with self-reported iodine sensitivity.Eye (London, England) · 2021Article
- Article
- Sub-clinical thickening of the fovea in diabetes and its relationship to glycaemic control: a study using swept-source optical coherence tomography.Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2021Article
- Relapse of pathological angiogenesis: functional role of the basement membrane and potential treatment strategies.Experimental & molecular medicine · 2021Review
- All India Ophthalmological Society members' survey: Practice pattern of intravitreal anti-vascular endothelial growth factor injection.Indian journal of ophthalmology · 2020Article
- Intravitreal Injections with Vascular Endothelial Growth Factor Inhibitors: A Practical Approach.Ophthalmology and therapy · 2020Article
- Preclinical Evaluation of a Cell-Based Gene Therapy Using the Sleeping Beauty Transposon System in Choroidal Neovascularization.Molecular therapy. Methods & clinical development · 2019Article
- Revascularization after angiogenesis inhibition favors new sprouting over abandoned vessel reuse.Angiogenesis · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesHigh-cost antivascular endothelial growth factor (anti-VEGF) medicines for eye disorders challenge ophthalmologists and policymakers to provide fair access for patients while minimising costs. We describe the growth in the use and costs of these medicines and measure inequalities in access.
designLongitudinal study using Hospital Episode Statistics (2005/2006 to 2014/2015) and hospital prescribing cost reports (2008/2009 to 2015/2016). We used Poisson regression to estimate standardised rates and explore temporal and geographical variations.
settingNational Health Service (NHS) care in England. POPULATION: Patients receiving anti-VEGF injections for age-related macular degeneration, diabetic macular oedema and other eye disorders.
interventionsHigher-cost drugs (ranibizumab or aflibercept) recommended by the National Institute for Health and Care Excellence or lower-cost drug (bevacizumab) not licensed for eye disorders.
main outcome measuresNational procedure rates and variation between and within clinical commissioning groups (CCGs). Cost of ranibizumab and aflibercept prescribing.
resultsInjection procedures increased by 215% between 2010/2011 and 2014/2015. In 2014/2015 there were 388 031 procedures (714 per 100 000). There is no evidence that the dramatic growth in rates is slowing down. Since 2010/2011 the estimated cost of ranibizumab and aflibercept increased by 247% to £447 million in 2015/2016, equivalent to the entire annual budget of a CCG. There are large inequalities in access; in 2014/2015 procedure rates in a 'high use' CCG were 9.08 times higher than in a 'low use' CCG. In the South-West of England there was twofold variation in injections per patient per year (range 2.9 to 5.9).
conclusionsThe high and rising cost of anti-VEGF therapy affects the ability of the NHS to provide care for other patients. Current regulations encourage the increasing use of ranibizumab and aflibercept rather than bevacizumab, which evidence suggests is more cost-effective. NHS patients in England do not have equal access to the most cost-effective care.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.