title: Cost and Selection of Ophthalmic Anti-Vascular Endothelial Growth Factor Agents.
abstract: Anti-vascular endothelial growth factor (anti-VEGF) drugs - ranibizumab, aflibercept, and off-label bevacizumab - are vital to the treatment of common retinal diseases, including exudative age-related macular degeneration (AMD), diabetic macular edema (DME), and macular edema (ME) associated with retinal vein occlusion (RVO). Given the high prevalence of AMD and retinal vascular diseases, anti-VEGF agents represent a large cost burden to the United States (US) healthcare system. Although ranibizumab and aflibercept are 30-fold more expensive per injection than bevacizumab, the two more costly medications are commonly used in the US, even though all three have been shown to be effective and safe for treatment of these retinal diseases. We investigated the availability and content of professional ophthalmic guidelines on cost consideration in the selection of anti-VEGF agents. We found that current professional guidelines were limited in availability and lacked specific guidance on cost-based anti-VEGF drug selection. This represents a missed opportunity to encourage the practice of value-based medicine. [Full article available at http://rimed.org/rimedicaljournal-2016-05.asp, free with no login].
authors.affiliation: transitional year resident at Signature Healthcare Brockton Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Dr. Li '11, '15 is a graduate of the Program in Liberal Medical Education at Brown University.
authors.forename: Emily
authors.initials: E
authors.lastname: Li
authors.affiliation: Professor of Surgery (Ophthalmology) at the Alpert Medical School and Chief of Ophthalmology at the Providence VA Medical Center in Providence, RI.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Greenberg
authors.affiliation: medical student at the Alpert Medical School of Brown University.
authors.forename: Indu
authors.initials: I
authors.lastname: Voruganti
authors.affiliation: Assistant Professor of Oph-thalmology at Harvard Medical School, a staff ophthalmologist at the Providence VA Medical Center, and an Adjunct Associate Clinical Professor of Surgery (Ophthalmology) at the Alpert Medical School of Brown University.
authors.forename: Magdalena G
authors.initials: MG
authors.lastname: Krzystolik
mesh_terms: D020533:Angiogenesis Inhibitors / Q000191:economics* / Q000627:therapeutic use; D000068258:Bevacizumab / Q000191:economics / Q000627:therapeutic use; D017850:Economics, Pharmaceutical; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy* / Q000191:economics; D056687:Off-Label Use; D009885:Ophthalmology; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D000069579:Ranibizumab / Q000191:economics / Q000627:therapeutic use; D040262:Receptors, Vascular Endothelial Growth Factor / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000191:economics / Q000627:therapeutic use; D012170:Retinal Vein Occlusion / Q000150:complications*; D014481:United States; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
chemical_list: D020533:Angiogenesis Inhibitors; D011993:Recombinant Fusion Proteins; D042461:Vascular Endothelial Growth Factor A; C533178:aflibercept; D000068258:Bevacizumab; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab
keywords: off-label drugs; ophthalmology; pharmacoeconomics; value-based medicine