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Ryu, Kim, Rim, Chung, and Kim: Prevalence of Exudative Age-related Macular Degeneration and Projections of the Cost of Ranibizumab in Korea
Original Article

J Korean Ophthalmol Soc 2019;60(3):253-260.

Published online: 25 September 2019

DOI: https://doi.org/10.3341/jkos.2019.60.3.253

Prevalence of Exudative Age-related Macular Degeneration and Projections of the Cost of Ranibizumab in Korea

Sunyoung Ryu, MD1, Dong Wook Kim, PhD2, Tyler Hyungtaek Rim, MD3, Eun Jee Chung, MD, PhD1, Jiwon Kim, MD1,

1Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang, Korea

2Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang, Korea

3Department 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

Received 21 June 2018       Revised 16 September 2018       Accepted 19 February 2019

Copyright © 2019 Korean Ophthalmological Society

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.

Keywords: Age-related macular degeneration, Health expenditure, Prevalence, Ranibizumab

References

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Figure 1.
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.
jkos-60-253f1.tif
Figure 2.
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.
jkos-60-253f2.tif
Figure 3.
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.
jkos-60-253f3.tif
Table 1.
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.

Table 2.
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
Table 3.
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.

Table 4.
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.

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