Do published trial results influence physician prescribing patterns? Intravitreal antivascular endothelial growth factor usage by the United States Ophthalmologists before and after Protocol T study

Shah, Serena; Markatia, Zahra; Watane, Arjun; Feldman, Alexandra; L, Shah; Sridhar, Jayanth

doi:10.1097/icu.0000000000000944

Current Opinion in Ophthalmology

2023

DOI: 10.1097/icu.0000000000000944

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Do published trial results influence physician prescribing patterns? Intravitreal antivascular endothelial growth factor usage by the United States Ophthalmologists before and after Protocol T study

Serena Shah

Zahra Markatia

Arjun Watane

et al.

Abstract: Purpose of reviewClinical trial publications may influence physician prescribing patterns. The Diabetic Retinopathy Clinical Research Network (DRCR.net) Protocol T study, published in 2015, examined outcomes of intravitreal antivascular endothelial growth factor (VEGF) medications for treatment of diabetic macular oedema (DME). This study investigates if the Protocol T 1-year results were associated with changes in prescribing patterns. Recent findingsAnti-VEGF agents have revolutionized treatment of DME by bl… Show more

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2024

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Bevacizumab First in DRCR Protocol AC vs Real-World Physician Treatment Choice for Diabetic Macular Edema: Two-Year Cost Analysis

Grewal,

Leung,

Busquets

et al. 2024

Journal of VitreoRetinal Diseases

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Purpose: To compare the modeled costs of the Protocol AC bevacizumab-first treatment protocol (with a switch to aflibercept for sub-responders) with real-world costs for treatment-naïve patients with diabetic macular edema (DME) over a 2-year period. Methods: Published data from the Diabetic Retinopathy Clinical Research Network (DRCR) Protocol AC bevacizumab-first arm (154 eyes) were used to model 2-year treatment costs. Real-world costs were modeled using data from the Vestrum Health electronic medical records database from a 2016 to 2018 cohort of treatment-naïve eyes with DME (n = 1062) treated with antivascular endothelial growth factor monotherapy. The visual acuity (VA) before treatment in the real-world cohort was matched to Protocol AC. A secondary cost analysis further matched VA gains after treatment in the real-world cohort (n = 346) to Protocol AC. Results: In Protocol AC, the modeled 2-year DME treatment cost in the bevacizumab-first arm was $18,952, with a mean of 16.1 injections over 22.5 visits and 70% of eyes being switched to aflibercept by year 2. (Within 2 years, 57% of injections were bevacizumab and 43% were aflibercept.) Over the same period, the modeled 2-year real-world cost ($11,459) was 40% lower, with a mean of 8.6 injections over 13.8 visits (42% bevacizumab, 45% aflibercept, 13% ranibizumab). Even when matched for baseline VA and a 14-letter VA gain over 2 years, the real-world cost ($15,394) was still 19% lower than the modeled cost in the Protocol AC bevacizumab-first arm. Conclusions: The real-world cost of treating DME over 2 years was significantly lower than the Protocol AC bevacizumab-first cost. Application of Protocol AC findings into real-world utilization, as with step therapy mandates, should only be considered if the same intensive protocol could be followed. These data suggest that existing real-world costs that reflect physician choice are already significantly lower than protocol-mandated step therapy, even when controlling for similar VA outcomes.

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Bevacizumab First in DRCR Protocol AC vs Real-World Physician Treatment Choice for Diabetic Macular Edema: Two-Year Cost Analysis

Grewal,

Leung,

Busquets

et al. 2024

Journal of VitreoRetinal Diseases

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show abstract

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Do published trial results influence physician prescribing patterns? Intravitreal antivascular endothelial growth factor usage by the United States Ophthalmologists before and after Protocol T study

Cited by 1 publication

References 27 publications

Bevacizumab First in DRCR Protocol AC vs Real-World Physician Treatment Choice for Diabetic Macular Edema: Two-Year Cost Analysis

Bevacizumab First in DRCR Protocol AC vs Real-World Physician Treatment Choice for Diabetic Macular Edema: Two-Year Cost Analysis

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