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Bevacizumab used more frequently than ranibizumab for Medicare beneficiaries with DME
Medicare beneficiaries are more likely to receive bevacizumab instead of ranibizumab for the treatment of diabetic macular edema, according to a study.
In a sample of Medicare beneficiaries from the Medicare Part B claims from 2010 to 2013, a greater proportion of patients with DME were treated with Avastin (bevacizumab, Genentech) compared with Lucentis (ranibizumab, Genentech). The sample included 5,290 Medicare beneficiaries with DME, of which 86.4% were treated with bevacizumab and 13.6% were treated with ranibizumab.
Geographic variations were examined by the researchers by comparing injection frequencies of the two drugs. The Mountain division, consisting of Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah and Wyoming, had the highest frequency of bevacizumab use, with 92.2% of patient receiving the injection. The Mid-Atlantic division, consisting of New Jersey, New York and Pennsylvania, had the lowest bevacizumab use, with 76% of patients receiving the injection. The highest frequency of ranibizumab use was noted in the Mid-Atlantic division, with 24% of patients receiving the injection.
The study authors said several factors may account for the significant regional differences in anti-VEGF use, including availability of each agent, patients factors such as Medigap insurance coverage, out-of-pocket costs and patient preference, and financial incentives for physicians. – by Robert Linnehan
Disclosures: The authors report no relevant financial disclosures.
Perspective
Back to TopIntravitreal injections of pharmacologic agents to block vascular endothelial growth factor have revolutionized the treatment of DME. Currently, retina specialists can choose between aflibercept, bevacizumab and ranibizumab as anti-VEGF agents, and all three of these agents are effective and safe treatment options. As more patients with diabetes develop diabetic retinopathy and DME, the number of patients that need treatment will increase, and adequate resources are needed to take care of this growing disease that threatens vision.
Wu and colleagues have provided important information on the frequency and variation of intravitreal bevacizumab and ranibizumab use for DME in Medicare beneficiaries in the United States. The authors obtained a 5% sample of Medicare beneficiaries from the Medicare Part B claims files from 2010 to 2013 and identified subjects with DME through ICD-CM code. They evaluated the data and found that there was greater bevacizumab use (86.4%) compared with ranibizumab use (13.6%). In addition, the frequency of bevacizumab use was greatest in the Mountain division (92.2%) and lowest in the Mid-Atlantic (76%). Wu and colleagues have given important insight into the geographic use of these anti-VEGF agents in this specific patient population. Additional research is necessary to understand the variations in practice patterns and prescription medication.
Despite the fact that bevacizumab’s use for the treatment of DME (and other retinal vascular diseases) is off label, it remains the most commonly prescribed anti-VEGF agent worldwide. Certainly, its comparatively low cost along with its effectiveness is an attractive combination. In this database, the ratio of bevacizumab to ranibizumab use was 6.4. Many factors, such as out-of-pocket costs, availability, practice guidelines and financial incentives, can affect the ultimate choice of medication for the patient. Physicians should be aware of the cost effectiveness of medications they prescribe because cost-savings strategies may play a larger role in health care policies.