• Anti-VEGF Use Among Privately Insured and Medicare Advantage Patients

    By Marianne Doran and selected by George B. Bartley, MD

    Journal Highlights

    Ophthalmology, March 2017

    Download PDF

    Parikh et al. characterized the trends during the first 10 years of ophthalmic usage of intravitreal anti-VEGF med­ications (bevacizumab, ranibizumab, and aflibercept). Their retrospective cohort study was based on administrative claims data for anti-VEGF injections from 2006 through 2015. They found that intravitreal anti-VEGF injections increased annually throughout this period and that the most common use was for treatment of age-related macu­lar degeneration (AMD).

    Using a data warehouse containing administrative claims data for more than 100 million commercial­ly insured and Medicare Ad­vantage patients, the researchers identified intravitreal anti-VEGF injections by means of Current Procedural Termi­nology codes. The main outcome measures were total and annual numbers of intravitreal anti-VEGF in­jections, as well as injections per 1,000 enrolled patients per general category of ophthalmic disease.

    A total of 959,945 anti-VEGF in­jections were given to 124,835 patients during the study period. Among all injections, 64.6% were bevacizumab, 22.0% were ranibizumab, and 13.4% percent were aflibercept. With regard to conditions treated, 62.7% of injections were for AMD, 16.1% were for diabetic retinal disease, 8.3% were for retinal vein occlusion, and 12.9% were for all other uses.

    For treatment of AMD, the use of bevacizumab and ranibizumab rose from 58.8 and 35.5 injections/1,000 patients, respectively, in 2006; peaked in 2011-2012 (338.6 and 137.7 injections/1,000, respectively); and decreased thereafter (294.4 and 100.7 injections/1,000 in 2015, respectively). In contrast, aflibercept use increased every year (in 2011, 1.1 injections/1,000 AMD patients; in 2015, 183.0 injections/1,000).

    For diabetic retinal disease, bevacizumab use increased each year (2.4 in­jections/1,000 patients in 2009 to 13.6/1,000 in 2015), while that of ranibizumab initially increased significantly and then declined after 2014 (0.1/1,000 in 2009, 6.3/1,000 in 2014, 4.0/1,000 in 2015). Aflibercept use increased each year for patients with diabetic retinal diseases and RVO (respectively, 0.001 and 0.05 injections/1,000 in 2011; 5.6 and 140.2 injections/1,000 in 2015).

    The authors concluded that intravitreal injections of anti-VEGF medica­tions increased annually from 2006 to 2015. Bevacizumab was most com­monly used, despite its lack of FDA approval for ophthalmic indications, and AMD was the most common condition treated. Ranibizumab use declined after 2014, while both the ab­solute and relative use of bevacizumab and aflibercept increased.

    The original article can be found here.