title: Treating age-related macular degeneration: comparing the use of two drugs among medicare and veterans affairs populations.
abstract: While new biologics have revolutionized the treatment of age-related macular degeneration-the leading cause of severe vision loss among older adults-these new drugs have also raised concerns over the economic impact of medical innovation. The two leading agents are similar in effectiveness but vary greatly in price-up to $2,000 per injection for ranibizumab compared to $50 for bevacizumab. We examined the diffusion of these drugs in fee-for-service Medicare and Veterans Affairs (VA) systems during 2005-11, in part to assess the impact that differing financial incentives had on prescribing. Physicians treating Medicare patients have a direct financial incentive to prescribe the more expensive agent (ranibizumab), while VA physicians do not. Medicare injections of the more expensive ranibizumab peaked in 2007 at 47 percent. Beginning in 2009 the less expensive bevacizumab became the predominant therapy for Medicare patients, accounting for more than 60 percent of injections. For VA patients, the distribution of injections across the two drugs was relatively equal, particularly from 2009 to 2011. Our analysis indicates that there are opportunities in both the VA and Medicare to adopt more value-conscious treatment patterns and that multiple mechanisms exist to influence utilization.
authors: Suzann Pershing is an assistant professor of ophthalmology at the Byers Eye Institute at Stanford, in Palo Alto, California, and chief of ophthalmology and eye care services at the Veterans Affairs (VA) Palo Alto Health Care System.
authors: Suzann
authors: S
authors: Pershing
authors: Christine Pal Chee is a health economist at the VA Health Economics Resource Center, in Menlo Park, California.
authors: Christine
authors: C
authors: Pal Chee
authors: Steven M. Asch is a professor of medicine at Stanford University School of Medicine, in Palo Alto, and chief of health services research and director of the Center for Innovation to Implementation, VA Palo Alto Health Care System.
authors: Steven M
authors: SM
authors: Asch
authors: Laurence C. Baker is a professor in health research and policy at Stanford University and a research associate at the National Bureau of Economic Research in Cambridge, Massachusetts.
authors: Laurence C
authors: LC
authors: Baker
authors: Derek Boothroyd is a senior biostatistician in medicine at Stanford University School of Medicine.
authors: Derek
authors: D
authors: Boothroyd
authors: Todd H. Wagner is a health economist and associate director of the Health Economics Resource Center, VA Palo Alto Health Care System and Stanford University.
authors: Todd H
authors: TH
authors: Wagner
authors: M. Kate Bundorf (bundorf@stanford.edu) is an associate professor in health research and policy at Stanford University School of Medicine and a faculty research fellow at the National Bureau of Economic Research.
authors: M Kate
authors: MK
authors: Bundorf
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D000068258:Bevacizumab / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D003365:Costs and Cost Analysis; D018588:Fee-for-Service Plans / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D056965:Injections, Intraocular; D007345:Insurance Claim Review; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000706:statistics & numerical data; D000069579:Ranibizumab / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D012051:Reimbursement Mechanisms / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States; D058014:Veterans Health / Q000191:economics* / Q000706:statistics & numerical data; D057135:Wet Macular Degeneration / Q000188:drug therapy* / Q000191:economics*
chemical_list: D020533:Angiogenesis Inhibitors; D000068258:Bevacizumab; D000069579:Ranibizumab
keywords: Biotechnology; Cost of Health Care; Elderly; Health Economics; Medicare