• Association Between Industry Payments and Anti-VEGF Use in Medicare Beneficiaries

    By Peggy Denny and selected by Andrew P. Schachat, MD

    Journal Highlights

    Ophthalmology Retina, January 2017

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    Mahr et al.
    conducted a cross-sectional database study to test for associations between anti-VEGF industry payments to ophthalmologists who provide intravitreal injections (IVI) and specific anti-VEGF agent use. They found that such payments were associated with higher odds of ranibizumab and aflibercept use and lower odds of bevacizumab use; however, this association did not demonstrate cause and effect.

    Participants in this study were U.S. fee-for-service Medicare beneficiaries and all ophthalmologists who sub­mitted IVI claims for >10 Medicare beneficiaries between Aug. 1, 2013, and Dec. 31, 2013. The Sunshine Act Open Payments database was searched for all industry financial relationships in oph­thalmology, and the Medicare Provider Utilization and Payment Database was searched for all IVI claims and anti-VEGF drug claims. The researchers used a novel algorithm to merge the 2 data sets and identify physician-specific associations between industry payments and use of anti-VEGF agents.

    The researchers found that of 3,391 ophthalmologists who performed IVI, 1,187 (35%) received nonresearch payments from anti-VEGF industry. Of these, 422 (35%) received payments from Regeneron, 363 (31%) from Genentech, and 402 (34%) from both. When compared with ophthalmologists who perform IVI but do not receive anti-VEGF industry payments, those receiving Genentech payments (me­dian, $90; interquartile range [IQR], $22-$149) were more likely to use ranibizumab (odds ratio [OR], 2.14); those receiving Regeneron payments (median, $55; IQR, $22-$131) were more likely to use ranibizumab (OR, 1.55) and aflibercept (OR, 1.23); those with payments from both manufactur­ers were more likely to use ranibizumab (OR, 2.69) and aflibercept (OR, 1.53); and all were less likely to use bevaci­zumab (OR, 0.33 to 0.64).

    The researchers concluded that anti-VEGF industry payments to ophthalmologists who perform IVI are associated with a greater likelihood of use of higher-cost ranibizumab and aflibercept; they noted, however, that the findings demonstrate only an association. They suggested that their algorithm could be used in future stud­ies of physician payments and prod­uct utilization and may increase our understanding of the role of payments on physician decision-making.

    The original article can be found here.

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