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Annual out-of-pocket eye injection costs to double to $3,900 under rebate cut – modelling

Prominent Australian Ms Ita Buttrose has used a National Press Club address to reveal alarming new data showing that 47,000 more Australians will experience severe vision loss or blindness if a Medicare rebate cut for intravitreal injections is given the green light.

The economic modelling was commissioned by the Macular Disease Foundation Australia (MDFA) and conducted by PwC in response to the MBS Taskforce Ophthalmology Draft Report 2019. The data has since been passed on to Federal Health Minister Greg Hunt.

Buttrose, an MDFA patron, used the Canberra speech on 5 May to warn that many older Australians will no longer be able to afford anti-VEGF treatments for disease like neovascular age-related macular degeneration (nAMD) if the Federal Government adopts a recommendation to slash the MBS fee from $310 with a rebate of around $250, to a $96 fee with a rebate of around $75.

The taskforce has proposed the reduction so that it aligned with “the more complex” peri/retrobulbar injections, item 18240.

“This treatment is highly successful in saving sight,” Buttrose said. “So why has the review taskforce recommended a reduction of 69% in the rebate for these eye injections? It’s a decision I find hard to fathom.”

Under the current system, she said within the first 12 months of injection treatment, adherence rates drop by 20-22% and then more than 50% by year five, leaving an estimated 80,000 Australians who progress to severe vision loss or blindness within five years.

Ita Buttrose with her uncle Gerard who has nAMD.

While there are several reasons for this, she said access and cost issues top the list because often there are limited or no eye health specialists near where people live, or they can’t access public hospital or bulk billed treatment. Currently, 29% receiving treatment are considering delaying or stopping due to costs, while 35% have cut back on expenditure such as food, groceries, other medicines and even mortgage payments to save their sight.

“Out-of-pocket costs for this treatment are already prohibitive,” Buttrose said. “Economic modelling commissioned by MDFA, predicts the proposed rebate cut will result in out-of-pocket costs increasing from $1,900 to $3,900 a year on average – double for patients needing injections in both eyes.

“This translates to an additional 47,000 Australians experiencing severe vision loss and blindness within the next five years.”

With Australia delivering some of the best nAMD outcomes globally, Buttrose used the address to call on the policymakers to reject the recommendation, and consider MDFA’s fully costed plans to improve access to sight-saving treatment.

“This rebate reduction, if approved, will deliver some savings to government, but will effectively be cost shifting to other parts of the health and welfare system,” she said.

“MDFA’s economic modelling forecasts an extra $168 million in direct costs to government in primary health, mental health care and early admissions to residential aged care. It’s estimated the proposed rebate cut would also lead to an additional $2.6 billion in indirect costs through loss of patient and family carer productivity.”

She added: “We know that successful treatment has kept many Australians out of fulltime care in nursing homes, which would cost the government far more than the subsidies for maintaining their sight.”

MDFA’s costed solutions

In response to the MBS Taskforce proposal, MDFA has developed three costed solutions to increase access to intravitreal injection treatment. It stated these models can be implemented immediately by leveraging existing systems and infrastructure:

  • New low cost-regional clinics, so patients can access treatment without needing to travel to metropolitan clinics that are already at capacity;
  • Increasing the number of healthcare workers who can give injections, such as ophthalmic registrars, under the supervision of qualified ophthalmologists;
  • Empowering patients to be better informed about fees so they can self-advocate if they can’t afford treatment.

“These models need both federal and state government investment. But the cost of doing nothing is much higher. Every 1,000 wet AMD patients left untreated costs the health system $20 million a year,” Buttrose said.

“Today, on behalf of MDFA, I call on the government to reject the recommendation to cut the MBS rebate for eye injections. We also ask ophthalmologists to work with the federal and state governments, and MDFA representing patients, to increase access to public and bulk-billed treatment in more locations across Australia.

“We simply cannot accept an Australia where we have a gold standard treatment to stop people from going blind, yet there are some Australians who can’t access it. Australians at risk of losing their vision can’t wait any longer – action is needed now.”

Buttrose made the comments during the inaugural Ita Buttrose Oration, an initiative of MDFA, and coincided with MDFA’s 20th anniversary and Macula Month this May. The oration series will be presented annually and will shine a spotlight on how the country is tracking to ensure a healthy ageing Australia.

Health Minister responds 

Following Buttrose’s speech, Minister Hunt was asked whether the government would reject the taskforce’s recommendation. He thanked Buttrose for her “important” macular degeneration work, but stressed there was a process to follow.

“We are, through our indigenous health futures missions, expanding access around the country for indigenous Australians with regards to a single goal, and that is by 2025, ending avoidable indigenous blindness. And macular degeneration is a critical part of that, so there is investment on that front,” he said.

“Then this [is] a report to government. There are many reports to government, and it’s not one which we have considered and determined yet. So I won’t pre-empt it. But our job is very clear, to make sure that every Australian has access to eye care as early as possible.”

More reading

MBS Taskforce keeps controversial eye injection proposals in final report

MBS eye injections plan could spell disaster for public system, ophthalmologist warns

Questions over economic viability of MBS proposals

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