Findings from a study published in Ophthalmic Epidemiology described trends in the use and costs of intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents, including aflibercept, ranibizumab, and bevacizumab, from 2014 to 2019.
Give me some background first.
Characterizing the factors that contribute to anti-VEGF injection adoption in patients insured by Medicare has only been recently possible.
Consequently, a research team sought to elucidate the determinants that influence state-wide disparities in anti-VEGF injections.
Now talk about the study.
Investigators utilized the Centers for Medicare and Medicaid Services’ Physician and Other Supplier Public Use File to extract Medicare Part B fee-for-service outpatient anti-VEGF injection claims submitted by ophthalmologists between 2014 and 2019.
Multivariable linear regression models were used to measure the association between reimbursement, ophthalmologist availability, and agent administration rate.
Findings?
During this time period, 17,588,995 intravitreal injection claims were filed by 4,218 ophthalmologists practicing in the United States.
Overall, Medicare costs for anti-VEGF injections increased from $2.51 billion in 2014 to $4.02 billion in 2019.
What caused this jump in Medicare costs?
Increased state-level ophthalmologist availability and incremental increases in average reimbursement amounts were found to be significantly associated with a 6.8-fold variation in overall anti-VEGF injection rates across states in 2019.
Note: States with a higher density of injecting physicians were linked with not only a higher rate of anti-VEGF injection but higher aflibercept and bevacizumab agent-specific injection rates as well.
Keep going…
Broken down by anti-VEGF agent, across the 50 states and the District of Columbia, injection rates varied:
- 7.3-fold for aflibercept
- 231.9-fold for ranibizumab
- 37.9-fold for bevacizumab
While the population-adjusted aflibercept injection rate increased 138% from 2014 to 2019, ranibizumab injection rates marginally increased—comparatively, bevacizumab injection rates slightly decreased.
Expert opinion?
According to the study authors, “Though aflibercept was initially approved for wet age-related macular degeneration (AMD), expanding indications (e.g., proliferative diabetic retinopathy [PDR] [and] diabetic macular edema [DME]) in the management of ophthalmic disease may partially explain the nationwide increase in injection rate.”
They added: “Additionally, the ability to extend patients for a longer period between injections may also explain an increase in aflibercept injection rates.”
Take home.
These findings indicated that both Medicare injection rates and costs for anti-VEGF injections increased from 2014 to 2019, predominantly due to increased aflibercept use.
There was a significant association between ophthalmologist availability and anti-VEGF injection rate on the state level, suggesting that access to care may contribute to the observed state-level disparities in intravitreal injection rates.
Next steps?
Additional studies further characterizing the factors that contribute to the state-level variation in anti-VEGF injection rates (i.e., physician-specific traits, regional characteristics, payments provided by the pharmaceutical industry, etc.) may help develop interventions to promote equitable access to and use of these therapies.