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

Abstract

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.

Intravitreal bevacizumab for diabetic macular oedema: 5-year results of the Pan-American Collaborative Retina Study group

“…The lower cost of bevacizumab, perceived effectiveness and relative safety make it a popular choice particularly in low-income and middle-income countries 4 5…”

“…However, intravitreal bevacizumab (IVB) has been widely used off-label despite approved therapies. The lower cost of bevacizumab, perceived effectiveness and relative safety makes it a popular choice particularly in the developing world 4 5. Numerous reports have presented beneficial visual and anatomical results 6–8.…”

Routine versus As-Needed Bevacizumab with 12-Weekly Assessment Intervals for Neovascular Age-Related Macular Degeneration

“…2,3 Aflibercept (Eylea; Bayer/Regeneron, Tarrytown, NY) is a more recent anti-VEGF therapeutic with a higher affinity for VEGF, and its use in clinical trials has demonstrated noninferiority in visual outcomes to monthly ranibizumab injections, despite only being injected every 2 months after the first loading dose phase. 4 As well as ranibizumab and aflibercept, many ophthalmologists globally use bevacizumab (Avastin, Genentech) off-label, which is a less-expensive anti-VEGF alternative 5 and has demonstrated noninferiority of visual outcomes compared with ranibizumab in large, randomized controlled trials. 6e9 Delivery regimens for each of these agents varies; treatment by monthly injections has been used as a gold standard strategy for visual outcomes in comparison trials, but is rarely followed in clinical practice, with most physicians opting for less frequent injection regimens using as-needed treatments, or regimens whereby treatment intervals are varied according to disease activity.…”

The role of ranibizumab in the management of diabetic retinopathy

“…Both ranibizumab monotherapy and in combination with laser resulted in gain in quality-adjusted life-years [66]. However, the increased quality achieved by the FDA-approved anti-VEGF agents comes at a high cost: US$1247 per one dose of 0.3 mg ranibizumab and $1970 per one dose of 2.0 mg aflibercept [67][68][69]. In comparison to ranibizumab and aflibercept, one injection of bevacizumab costs approximately US$50 [70].…”