Treating Age-Related Macular Degeneration: Comparing The Use Of Two Drugs Among Medicare And Veterans Affairs Populations

Abstract

While new biologics have revolutionized the treatment of age-related macular degeneration-the leading cause of severe vision loss among older adults-these new drugs have also raised concerns over the economic impact of medical innovation. The two leading agents are similar in effectiveness but vary greatly in price-up to $2,000 per injection for ranibizumab compared to $50 for bevacizumab. We examined the diffusion of these drugs in fee-for-service Medicare and Veterans Affairs (VA) systems during 2005-11, in part to assess the impact that differing financial incentives had on prescribing. Physicians treating Medicare patients have a direct financial incentive to prescribe the more expensive agent (ranibizumab), while VA physicians do not. Medicare injections of the more expensive ranibizumab peaked in 2007 at 47 percent. Beginning in 2009 the less expensive bevacizumab became the predominant therapy for Medicare patients, accounting for more than 60 percent of injections. For VA patients, the distribution of injections across the two drugs was relatively equal, particularly from 2009 to 2011. Our analysis indicates that there are opportunities in both the VA and Medicare to adopt more value-conscious treatment patterns and that multiple mechanisms exist to influence utilization.

The use of bevacizumab and ranibizumab for branch retinal vein occlusion in medicare beneficiaries

“…While bevacizumab represented the majority of injections for AMD within Medicare, the distribution between bevacizumab and ranibizumab was relatively equal from 2009 to 2011 within the Veterans Health Administration (VHA), an integrated healthcare system without financial prescribing incentives for physicians. 13 This may reflect higher Medicare copayments on ranibizumab, while service-connected disability and low-income exemptions reduce such financial pressures on VHA patients. 13 Most Medicare patients in our study period had low CCI scores (1–2), which may not be the case for other populations such as patients receiving care in the VHA 16 ; further studies are needed to determine whether level of comorbidity among BVO patients affects utilization of anti-VEGF therapy.…”

“… 13 This may reflect higher Medicare copayments on ranibizumab, while service-connected disability and low-income exemptions reduce such financial pressures on VHA patients. 13 Most Medicare patients in our study period had low CCI scores (1–2), which may not be the case for other populations such as patients receiving care in the VHA 16 ; further studies are needed to determine whether level of comorbidity among BVO patients affects utilization of anti-VEGF therapy. In certain practices, ranibizumab patients receive better coverage for drug costs (e.g.…”

“… 10 , 11 , 12 Previous studies have identified regional and provider factors associated with overall variation in anti-VEGF use. 10 , 11 , 12 , 13 , 14 , 15 However, the geographic variation of anti-VEGF use for the treatment of RVO has not been well described. The public release of FFS Medicare claims data by the Centers for Medicare and Medicaid Services (CMS) in 2014 has enabled greater transparency in drug and payment variation.…”

The Effects of Bevacizumab in Augmenting Trabeculectomy for Glaucoma

“…Despite bevacizumab and MMC had similar efficacy in the IOP reduction and success rate, bevacizumab was much more expensive than MMC, with approximately $450 for each bevacizumab vial. 37 If we use each vial of bevacizumab for multiple injections, the per dose price will potentially much lower than $450, depending on the number of injections per vial. However, each bevacizumab vial was allowed to use for only 1 injection because of the contamination outbreaks, discarding the leftover amount.…”

Regionale Unterschiede in der Versorgung von Patienten mit neovaskulärer altersabhängiger Makuladegeneration in einer nicht interventionellen Beobachtungsstudie (OCEAN)

“…Eine steigende Rate von Therapieabbrechern kann möglicherweise ihren Ursprung in einer unzureichenden Basisdiagnostik haben [17]. Während die Auswertung von Abrechnungsdaten einen Überblick über die entstandenen Kosten erlaubt [18,19], besteht die Stärke einer prospektiven Studie darin, mögliche Parameter der Prozess-und Ergebnisqualität vollumfänglich zu erfassen. Die Rationale der nicht interventionellen OCEAN-Studie (Observation of treatment patterns with LuCEntis and real life ophthalmic monitoring, including optional OCT in Approved iNdications) ist es, den Einfluss der empfohlenen Diagnostik mittels optischer Kohärenztomo-grafie (OCT) im Behandlungsalltag zu erfassen [20].…”