Diffusion of Technologies for the Care of Older Adults With Exudative Age-Related Macular Degeneration

Stein, Joshua D.; Hanrahan, Brian W.; Comer, Grant M.; Sloan, Frank A.

doi:10.1016/j.ajo.2012.10.003

Cited by 22 publications

(12 citation statements)

References 25 publications

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“…30 Growth predicted by using the logistic curve matched reasonably well with historical data on the fraction of patients with neovascular age-related macular degeneration receiving anti-VEGF therapies 28,29 (Appendix Exhibit A2). 22 Since adoption of anti-VEGF therapies is lower for diabetic macular edema than for neovascular age-related macular degeneration (because FDA approval occurred later), we applied the growth pattern observed for neovascular age-related macular degeneration to diabetic macular edema.…”

Section: Study Data and Methodsmentioning

confidence: 58%

Switching To Less Expensive Blindness Drug Could Save Medicare Part B $18 Billion Over A Ten-Year Period

et al. 2014

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The biologic drugs bevacizumab and ranibizumab have revolutionized treatment of diabetic macular edema and macular degeneration, leading causes of blindness. Ophthalmologic use of these drugs has increased, now accounting for roughly one-sixth of the Medicare Part B drug budget. Ranibizumab and bevacizumab have similar efficacy and potentially minor differences in adverse event rates, but at $2,023 per dose, ranibizumab costs forty times more than bevacizumab. Using modeling methods, we predict ten-year (2010–2020) population-level costs and health benefits of using bevacizumab and ranibizumab. Our results show that if all patients were treated with the less-expensive bevacizumab instead of current usage patterns, Medicare Part B, patients, and the health care system would save $18 billion, $4.6 billion, and $29 billion, respectively. Altering patterns of use with these therapies by encouraging bevacizumab use and hastening approval of biosimilar therapies would dramatically reduce spending without substantially affecting patient outcomes.

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Section: Study Data and Methodsmentioning

confidence: 58%

Switching To Less Expensive Blindness Drug Could Save Medicare Part B $18 Billion Over A Ten-Year Period

et al. 2014

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“…Thus, we considered 2006 as the first anti-VEGF treatment year Since corticosteroids came into use at about the same time as anti-VEGF therapies were first introduced, our analysis could not distinguish between the introduction dates for two innovations, although corticosteroids were much less commonly used than PDT and anti-VEGF therapies were. 14 For this reason, changes in vision at the population level after introduction of anti-VEGF therapies are attributable to introduction of this technology rather than to use of corticosteroids.…”

Section: Methodsmentioning

confidence: 99%

“…Today anti-VEGF therapy has diffused to the point of being the treatment of choice for exudative AMD. 14 …”

mentioning

confidence: 99%

The Effects of Technological Advances on Outcomes for Elderly Persons With Exudative Age-related Macular Degeneration

Sloan

Hanrahan

2014

JAMA Ophthalmol

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IMPORTANCE Exudative age-related macular degeneration (ARMD) is the major cause of blindness among US elderly. Developing effective therapies for this disease has been difficult.OBJECTIVES To assess the effects of introducing new therapies for treating exudative ARMD on vision of the affected population and other outcomes among Medicare beneficiaries newly diagnosed as having ARMD.DESIGN The study used data from a 5% sample of Medicare claims and enrollment data with a combination of a regression discontinuity design and propensity score matching to assess the effects on the introduction or receipt of new technologies on study outcomes during a 2-year follow-up period. SETTING AND PARTICIPANTSThe analysis was based on longitudinal data for the United States, January 1, 1994, to December 31, 2011, for Medicare beneficiaries with fee-for-service coverage. The sample was limited to beneficiaries 68 years or older newly diagnosed as having exudative ARMD as indicated by beneficiaries having no claims with this diagnosis in a 3-year look-back period.EXPOSURES The comparisons with vision outcomes were after vs before the introduction of photodynamic therapy and anti-vascular endothelial growth factor (VEGF) therapy. The comparisons for depression and long-term care facility admission were between beneficiaries newly diagnosed as having exudative ARMD who received photodynamic therapy or anti-VEGF therapy compared with beneficiaries having the diagnosis who received no therapy for this disease. MAIN OUTCOMES AND MEASURESOnset of decrease in vision, vision loss or blindness, depression, and admission to a long-term care facility. RESULTS Among beneficiaries newly diagnosed as having exudative ARMD, the introduction of anti-VEGF therapy reduced vision loss by 41% (95% CI, 52%-68%) and onset of severe vision loss and blindness by 46% (95% CI, 47%-63%). Such beneficiaries who received anti-VEGF therapy and were not admitted to a long-term care facility during the look-back period were 19% (95% CI, 72%-91%) less likely on average to be admitted to a long-term care facility during the follow-up period.CONCLUSIONS AND RELEVANCE This study demonstrates gains in population vision from the introduction of anti-VEGF therapy for patients 68 years or older with an exudative ARMD diagnosis in community-based settings in the United States.

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“…This study extended another intent-to-treat analysis based on the same data which assessed changes in vision outcomes 25 following widespread use of anti-VEGF agents for treating exudative AMD. 26 …”

Section: Discussionmentioning

confidence: 99%

Introducing Anti-Vascular Endothelial Growth Factor Therapies for AMD Did Not Raise Risk of Myocardial Infarction, Stroke, and Death

Yashkin

Hahn²,

Sloan

2016

Ophthalmology

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Purpose To assess the effect of availability of anti-VEGF therapy on mortality and hospitalizations for stroke and acute myocardial infarction (AMI) over a 5-year follow-up period in US Medicare beneficiaries newly diagnosed with exudative age-related macular degeneration (AMD) in 2006 compared to control groups consisting of beneficiaries newly diagnosed with exudative AMD at a time when anti-VEGF therapy was not possible and with a control group of beneficiaries newly diagnosed with non-exudative AMD. Design Retrospective cohort study Participants Medicare beneficiaries newly diagnosed with exudative and non-exudative AMD in 2000 and 2006 selected from a random longitudinal sample of Medicare 5% claims and enrollment files. Methods Beneficiaries with a first diagnosis of exudative AMD in 2006 were the treatment group; beneficiaries newly diagnosed with exudative AMD in 2000 or non-exudative AMD in 2000 or 2006 were control groups. To deal with potential selection bias, we designed an intent-to-treat study. Intent-to-treat analysis controls for non-adherence to prescribed regimens. In our study, the treatment group consisted of patients with clinically appropriate characteristics to receive anti-VEGF injections given that the therapy is available, by-passing the need to monitor whether treatment was actually received. Control groups consisted of patients with clinically appropriate characteristics but first diagnosed at a time when the therapy was unavailable (2000) and similar patients but for whom the therapy is not clinically indicated (2000, 2006). We used a Cox proportional hazard model. Main Outcome Measures All-cause mortality and hospitalization for stroke and AMI during follow-up. Results No statistically significant changes in probabilities of death and hospitalizations for AMI and stroke within a 5-year follow-up period were identified in exudative AMD beneficiaries newly diagnosed in 2006, the beginning of widespread anti-VEGF use, compared to 2000. As an alternative to our main analysis, which excluded beneficiaries from non-exudative AMD group who received anti-VEGF therapies during follow-up, we performed a sensitivity analysis with this group of individuals re-included (11% of beneficiaries newly diagnosed with non-exudative AMD in 2006). Results were similar. Conclusions Data from this study do not show that the introduction of anti-VEGF agents in 2006 for treating exudative AMD has posed a threat of increased risk of AMI, stroke, or all-cause mortality.

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Diffusion of Technologies for the Care of Older Adults With Exudative Age-Related Macular Degeneration

Cited by 22 publications

References 25 publications

Switching To Less Expensive Blindness Drug Could Save Medicare Part B $18 Billion Over A Ten-Year Period

Switching To Less Expensive Blindness Drug Could Save Medicare Part B $18 Billion Over A Ten-Year Period

The Effects of Technological Advances on Outcomes for Elderly Persons With Exudative Age-related Macular Degeneration

Introducing Anti-Vascular Endothelial Growth Factor Therapies for AMD Did Not Raise Risk of Myocardial Infarction, Stroke, and Death

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