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

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

    Ophthalmology, March 2017

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    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.