Patterns of Intravitreal Injection Utilisation, Treatment Burden, and Cost Implications in a Public Ophthalmology Service: A Retrospective Audit
Abstract
A retrospective clinical audit examining intravitreal injection utilisation, treatment patterns and drug acquisition costs within a public ophthalmology service.
The global rise of intravitreal treatment has affected ophthalmic service delivery, workforce requirements and healthcare costs. Public ophthalmology services must balance increasing clinical demand with sustainable resource use. This study assessed intravitreal injection patterns, temporal trends and associated drug procurement costs within a public ophthalmology service.
A retrospective clinical audit was undertaken covering intravitreal injections administered between June 2023 and September 2025. Data were obtained from intravitreal therapy registers and included injection volume, agent selection, laterality and monthly utilisation trends. Drug procurement costs were obtained from institutional pharmacy records. Data were anonymised and analysed descriptively.
A total of 1,446 intravitreal injections were administered during the audit period. Anti-VEGF therapy represented most activity, with aflibercept formulations accounting for 55.2% of injections. High-dose aflibercept (8 mg) showed rapid adoption following its introduction. The reported total drug acquisition cost was €697,504.90, with aflibercept accounting for the greatest proportion of expenditure.
Intravitreal therapy represents a substantial clinical and economic burden for public ophthalmology services. The observed prescribing patterns suggest that clinical effectiveness and treatment durability may be more influential than acquisition cost alone. Continuous auditing and service-level evaluation can support sustainable service delivery, workforce planning and policy development.
Intravitreal injections recorded during the audit period.
June 2023 through September 2025.
Combined aflibercept formulations represented more than half of injections.
Reported direct drug acquisition expenditure across the audit.
Aflibercept Dominated Activity
Aflibercept 2 mg accounted for 518 injections and aflibercept 8 mg for 281 injections, representing 35.8% and 19.4% respectively. Together, the two formulations accounted for 55.2% of all recorded injections.
Rapid Uptake of High-Dose Aflibercept
Following the introduction of aflibercept 8 mg in September 2024, utilisation increased rapidly. The published analysis reports that within four months it had become the most administered agent, while use of some alternative agents declined.
High-Volume Procedural Care
The audit demonstrates the sustained workload associated with intravitreal therapy and highlights the importance of efficient injection pathways, workforce planning, interdisciplinary support and service capacity.
Substantial Pharmaceutical Expenditure
Drug acquisition costs represented a significant financial burden. The reported analysis was restricted to direct pharmaceutical procurement costs and excluded staffing, equipment, consumables, infrastructure and overhead costs.
Audit & Service Evaluation
The study was classified as a retrospective clinical audit and service evaluation using anonymised data. Formal ethical approval and informed consent were therefore not required under the governance framework described in the published article.
Continuous Audit for Sustainable Care
Regular review of intravitreal utilisation can support procurement decisions, workforce planning, service redesign and quality improvement while helping ophthalmology services respond to changing treatment patterns.
Citation Metrics
Citation counts are retrieved from independent scholarly databases. Counts are displayed separately because indexing coverage and citation matching differ between services.
Citations reported through the Crossref scholarly metadata network.
Loading…Citations indexed by the OpenAlex scholarly knowledge graph.
Loading…Citation Generator
Select a referencing style, copy the citation, or export the article record for use with reference-management software.
Retrospective Clinical Audit
The study was conducted as a retrospective clinical audit and service evaluation examining real-world intravitreal treatment activity within a public ophthalmology service.
June 2023 – September 2025
Intravitreal therapy registers were reviewed across a 27-month period to assess injection volume, agent selection, laterality, temporal trends and associated drug acquisition costs.
Descriptive Service Evaluation
Anonymised data were compiled and analysed descriptively. The published methodology also used the Donabedian model to conceptualise service performance across structure, process and outcome-related domains.
Direct Drug Procurement Costs
The economic analysis was restricted to institutional pharmaceutical acquisition costs. VAT, staffing, equipment, consumables, infrastructure and other operating expenses were excluded from the reported total.
Service Evaluation Audit
The study involved retrospective analysis of anonymised service data. Formal ethical approval and informed consent were not required under the governance approach described by the authors. Data handling was reported as conforming with GDPR requirements.
Single-Service Retrospective Audit
The published limitations include the retrospective design and focus on a single service. Patient demographics, clinical outcomes and indirect costs were not analysed.
CRediT Contribution Statement
Thomas Ahern:
Original draft and formal analysis.
Adebusola Adenike Owokole:
Review, editing and data curation.
Conall Hurley:
Supervision.
Conflict of Interest & Funding
Conflict of Interest:
No conflict of interest.
Funding:
No funding received by the authors.
Clinical Service Teams
The authors acknowledge the diverse teams supporting intravitreal therapy delivery.
Editorial Timeline
CC BY 4.0
This article is published by
The Operating Room Global Journal (TORGJ)
under the Creative Commons Attribution
4.0 International licence.
Persistent DOI:
10.64573/torgj2512002
Volume 1 · Issue 2 · 2025
The Operating Room Global Journal (TORGJ). ISSN 3105-3262. Article DOI: 10.64573/torgj2512002.
Semantic Scholar
This article has a Semantic Scholar record.
View on Semantic Scholar ↗
Access the Published Article
Read the official full-text article, access the persistent DOI record, or browse Volume 1, Issue 2.