JKOS Journal of the Korean Ophthalmological Society J Korean Ophthalmol Soc 0378-6471 2092-9374 Korean Ophthalmological Society 10.3341/jkos.2019.60.3.253 jkos-60-253 Original Article Prevalence of Exudative Age-related Macular Degeneration and Projections of the Cost of Ranibizumab in Korea RyuSunyoung MD 1 KimDong Wook PhD 2 RimTyler Hyungtaek MD 3 ChungEun Jee MD, PhD 1 KimJiwon MD 1 Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang, Korea Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang, Korea Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea Address reprint requests to Jiwon Kim, MD Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, #100 Ilsan-ro, Ilsandong-gu, Goyang 10444, Korea Tel: 82-31-900-0590, Fax: 82-31-900-0049 E-mail: plusm13@gmail.com 09 2019 25 09 2019 603 253 260 21062018 16092018 19022019 Copyright © 2019 Korean Ophthalmological Society 2019 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose

To analyze the incidence and prevalence of exudative age-related macular degeneration (AMD) and to predict the future AMD populations and health expenditures of intravitreal ranibizumab injection.

 Methods

From 2010 to 2014, the National Health Insurance claims data were used to estimate the incidence and prevalence change of exudative AMD, according to demographic characteristics (year, sex, residence, and age). Based on the above results and changes in future population distribution, we estimated the AMD population by 2030. Considering the cost of Intravitreal ranibizumab injection from 2010 to 2014, we predicted the future health expenditure for AMD.

 Results

The incidence and prevalence of exudative AMD increased from 14.04 and 295.11 per 100,000 populations in 2010 to 14.25 and 580.71 in 2014, respectively. The prevalence rate was higher in men and showed a large increase over 70 years of age. The ranibizumab was prescribed 13 times per person in average, and the amount consumed increased as the number of insurance coverage increased from 2013. Future AMD populations are predicted to reach 557,007 in 2030 from 146,871 in 2014. As a result, the cost of intravitreal ranibizumab injection is expected to increase from 83.6 billion won in 2014 to 171.7 billion won in 2030.

 Conclusions

The increase in medical expenses for AMD is expected due to social aging. Therefore, we need policies to secure medical resources and expand insurance indications.

 Age-related macular degeneration Health expenditure Prevalence Ranibizumab References Congdon N O'Colmain B Klaver CC Causes and prevalence of visual impairment among adults in the United States Arch Ophthalmol 2004 12247785 Klein R Klein BE Linton KL Prevalence of age-related maculopathy. The Beaver Dam Eye Study Ophthalmology 1992 9993343 World Health Organization Vision 2020: the right to sight Global initiative for the elimination of avoidable blindness: action plan 2006–2011 http://apps.who.int/iris/handle/10665/43754 Accessed February 24, 2014. Lee PP Feldman ZW Ostermann J Longitudinal prevalence of major eye diseases Arch Ophthalmol 2003 121130310 Rein DB Wittenborn JS Zhang X Forecasting age-related macular degeneration through the year 2050: the potential impact of new treatments Arch Ophthalmol 2009 12753340 Wong WL Su X Li X Global prevalence of age-related abdominal degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis Lancet Glob Health 2014 2e10616 Park SJ Lee JH Woo SJ Age-related macular degeneration: prevalence and risk factors from Korean National Health and Nutrition Examination Survey, 2008 through 2011 Ophthalmology 2014 121175665 Cho BJ Heo JW Kim TW Prevalence and risk factors of age-related macular degeneration in Korea: the Korea National Health and Nutrition Examination Survey 2010–2011 Invest Ophthalmol Vis Sci 2014 5511018 Statistics Korea Population Projections for Korea: 2010–2060 (Based on the 2010 Census) Korean Statistical Information Service http://kosis.kr/publication/publicationThema.do Accessed August 1, 2012. Statistics Korea Population Statistics Based on Resident Registration 2014 Korean Statistical Information Service http://kosis.kr/pub-lication/publicationThema.do Accessed March 1, 2018. Rim TH Choi M Yoon JS Kim SS Sociodemographic and health behavioural factors associated with access to and utilisation of eye care in Korea: Korea Health and Nutrition Examination Survey 2008–2012 BMJ Open 2015 5e007614 Hyun KR Kang S Lee S Population aging and healthcare expenditure in Korea Health Econ 2016 25123951 Figures and Tables

The incidence and prevalence change of exudative AMD according to demographic characteristics (year, sex, residence, and age) (person/100,000 populations). Age-standardized incidence and prevalence rate by sex (A, B), incidence and prevalence rate by age group (C, D), age-standardized incidence and prevalence rate by residence (E, F). AMD = age-related macular degeneration.

The number of Ranibizumab pre-scriptions by year and percentage of Ranibizumab use in new exudative AMD patients. Number of Ranibizumab prescription (solid line), percentage of Ranibizumab use in new AMD patients (dashed line). AMD = age-related macular degeneration.

Predicted population and incidence of exudative AMD by year. Based on the incidence from 2010 to 2014 and future population estimates, the population of exudative AMD is expected to increase gradually. AMD = age-related macular degeneration.

Change of incidence and prevalence rate (person/100,000 populations)

    2010 2011 2012 2013 2014
Incidence rate Total 14.04 12.91 12.74 13.38 14.25
  Male 15.99 15.41 15.26 16.40 17.39
  Female 12.08 10.40 10.22 10.37 11.10
Age standardized incidence rate* Total 14.30 12.66 11.90 12.04 13.15
  Male 16.18 14.93 13.98 14.39 15.31
  Female 12.37 10.28 9.66 9.48 10.61
Prevalence rate Total 295.11 361.74 458.48 519.70 580.71
  Male 341.42 417.81 534.62 609.84 687.48
  Female 248.64 305.52 382.21 429.50 473.96
Age standardized prevalence rate* Total 300.84 354.89 427.20 466.20 535.74
  Male 345.74 404.60 487.44 531.87 600.91
  Female 254.83 302.57 361.56 392.70 453.87

The standard population was used as the resident population of Korea in 2010.

Distribution of incidence and prevalence rate by age group (person/100,000 populations)

  Year <40 40–49 50–59 60–69 70–79 ≥80
Incidence rate 2010 0.15 1.71 13.69 52.29 101.70 106.72
  2011 0.07 1.07 11.75 46.12 91.48 99.77
  2012 0.09 0.94 10.59 41.55 88.55 98.22
  2013 0.05 0.71 10.79 41.22 90.37 103.92
  2014 0.04 0.82 11.23 43.22 100.11 122.01
Prevalence rate 2010 2.17 19.94 196.62 1,097.31 2,365.16 2,485.03
  2011 1.18 15.40 223.27 1,300.12 2,840.37 2,949.07
  2012 1.01 15.97 271.10 1,470.31 3,496.81 3,779.32
  2013 0.43 14.09 278.56 1,569.56 3,845.52 4,379.89
  2014 0.87 14.91 275.44 1,703.97 4,522.21 5,527.41

Distribution of incidence and prevalence rate by region (person/100,000 populations)

  Year Seoul Metropolitan Gyeonggi/Gangwon-do Chung-cheong-do Jeolla-do G Gyeong-sang-do Jeju-do
Incidence rate 2010 14.48 13.96 12.05 12.70 20.20 14.68 11.70
  2011 13.96 13.14 11.47 11.13 17.75 12.24 13.57
  2012 13.11 13.13 11.51 10.21 16.23 13.94 11.64
  2013 14.29 13.46 12.43 10.42 16.77 14.03 12.31
  2014 16.54 14.61 12.35 10.64 18.36 13.96 13.91
Age standardized incidence rate* 2010 14.48 13.96 12.05 12.70 20.20 14.68 11.70
  2011 13.26 12.51 10.88 10.80 17.20 11.80 12.98
  2012 11.79 11.90 10.47 9.65 16.20 13.00 10.77
  2013 12.20 11.64 10.82 9.54 16.14 12.64 11.12
  2014 13.42 12.11 10.36 9.49 17.35 12.19 12.24
Prevalence rate 2010 262.44 354.34 232.99 246.40 451.09 280.20 349.93
  2011 335.27 445.29 284.54 262.67 549.01 354.10 345.07
  2012 443.48 579.73 351.58 308.39 606.29 477.94 435.75
  2013 517.88 631.69 404.16 382.05 689.58 531.41 537.39
  2014 596.06 715.72 443.27 396.18 789.15 577.22 521.46
Age standardized prevalence rate* 2010 262.44 354.34 232.99 246.40 451.09 280.20 349.93
  2011 317.78 423.18 270.18 255.32 532.75 341.85 328.75
  2012 396.51 523.47 319.54 291.19 606.45 445.66 402.55
  2013 437.80 542.18 351.79 349.69 667.33 479.45 482.81
  2014 478.66 587.39 370.94 354.18 744.65 504.49 457.37

The standard population was used as the resident population of Korea in 2010.

Predicted population and incidence of AMD

Year Total population Population over 40 years AMD population New AMD patients Health expenditures of ranibizumab (1,000 won)
2010 49,410,366 22,979,003 146,871 6,985 62,776,000
2014 50,423,955 25,629,560 294,195 7,218 83,634,000
2015* 50,015,202 25,708,391 301,397 7,398 96,174,000
2020* 49,823,972 27,726,757 416,063 9,004 117,052,000
2025* 49,212,973 29,360,904 508,902 11,039 143,507,000
2030* 48,268,309 30,207,650 557,007 13,213 171,769,000

The price of Ranibizumab is assumed to be 1 million won. The percentage of Ranibizumab use among new AMD patients is calculated to be approximately 55% and the average of 13 times of injection. AMD = age-related macular degeneration.

Predicted values.