Treating Exudative AMD With Bevacizumab Is Highly Cost-Effective
American Journal of Ophthalmology, July 2018
In a cost analysis of bevacizumab, ranibizumab, and aflibercept, Rosenfeld et al. estimated the relative savings associated with bevacizumab in the treatment of exudative age-related macular degeneration (AMD) in the United States. The authors projected that the substitution of bevacizumab for the other treatments could yield savings of 80% for Medicare and 20% for patients.
The main outcome measure in this retrospective review was Medicare spending on bevacizumab, ranibizumab, and aflibercept from 2008 through 2015. Spending was tracked using the CPT code for intravitreal injections (67028) and treatment-specific J codes (J0178, J2778, J9035, J3490, J3590) for anti–vascular endothelial growth factor (anti-VEGF) agents. Associated claims were identified from Medicare Provider Utilization and Payment Data files from the Centers for Medicare & Medicaid Services among fee-for-service Medicare beneficiaries and from the 100% fee-for-service Part B Medicare Claims File. Bevacizumab claims unrelated to ophthalmology were excluded.
The average cost of a dose of bevacizumab ranged from $60.86 in 2008 to $73.03 in 2015. The average cost of a dose of ranibizumab exceeded $2,000 in all years of the study, as did that of aflibercept once it became available. From 2008 to 2015, bevacizumab use resulted in overall savings of approximately $17.3 billion: $13.8 billion for Medicare and $3.5 billion for patients. The savings for Medicare represent an underestimation because roughly 30% of Medicare-eligible people are enrolled in Medicare Advantage plans, which were not included in the study. Even more savings would have been realized by including eye disorders other than AMD that are treated with anti-VEGF agents, such as diabetic macular edema and retinal vein occlusion.
Off-label bevacizumab use is expanding because of its low cost, widespread availability, and effectiveness for exudative and neovascular ocular conditions. Concern has arisen in the United States and elsewhere regarding improper compounding of bevacizumab. In light of the drug’s substantial cost savings and dominant position as the treatment of choice for exudative AMD, emphasis should be placed on ensuring a safe and readily available supply.
The original article can be found here.