title: Pharmacotherapy for neovascular age-related macular degeneration: an analysis of the 100% 2008 medicare fee-for-service part B claims file.
abstract: OBJECTIVE
  To describe the usage patterns of pharmacological treatments for neovascular age-related macular degeneration (AMD) in Medicare fee-for-service beneficiaries.
  
  
  METHODS
  Retrospective review of all Medicare fee-for-service Part B claims for neovascular AMD during 2008.
  
  
  METHODS
  Medicare beneficiaries having undergone treatment were identified. The data collected for each visit for a given beneficiary included age, race, gender, Medicare region, state/zip code of residence, date of visit, whether or not the beneficiary had a treatment, the type and amount of drug, and dollars paid by Medicare. The main outcome measures were the number and rate of treatments, the types of drugs used for treatment, and the payments for these drugs.
  
  
  RESULTS
  Of the 222 886 unique beneficiaries, 146 276 (64.4%) received bevacizumab and 80 929 (35.6%) received ranibizumab. A total of 824 525 injections were performed with 480 025 injections of bevacizumab (58%) and 336 898 injections of ranibizumab (41%). National rates of injections per 100 000 fee-for-service Part B Medicare beneficiaries for bevacizumab and ranibizumab were 1506 and 1057, respectively. Total payments by Medicare were $20 290 952 for bevacizumab and $536 642 693 for ranibizumab. In 39 out of 50 states, the rate of injection was higher for bevacizumab compared with ranibizumab.
  
  
  CONCLUSIONS
  In 2008, bevacizumab was used at a higher rate than ranibizumab for the treatment of neovascular AMD. Even though bevacizumab accounted for 58% of all injections, Medicare paid $516 million more for ranibizumab than bevacizumab. These data suggest that despite its off-label designation, intravitreal bevacizumab is currently the standard-of-care treatment for neovascular AMD in the United States.
authors.affiliation: Centers for Medicare and Medicaid Services, Woodlawn, MD 21244, USA. ross.brechner@cms.hhs.gov
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Brechner
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Rosenfeld
authors.forename: J Daniel
authors.initials: JD
authors.lastname: Babish
authors.forename: Stuart
authors.initials: S
authors.lastname: Caplan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide / Q000008:administration & dosage; D000068258:Bevacizumab; D020256:Choroidal Neovascularization / Q000188:drug therapy*; D004358:Drug Therapy; D017723:Drug Utilization Review; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000188:drug therapy*; D008297:Male; D016345:Medicare Part B / Q000706:statistics & numerical data*; D008875:Middle Aged; D011166:Porphyrins / Q000008:administration & dosage; D000069579:Ranibizumab; D012189:Retrospective Studies; D014481:United States; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D000077362:Verteporfin
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide; D011166:Porphyrins; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000077362:Verteporfin; C495058:pegaptanib; D000068258:Bevacizumab; D000069579:Ranibizumab