title: Open Payments Database: Anti-Vascular Endothelial Growth Factor Agent Payments to Ophthalmologists.
abstract: OBJECTIVE
  To analyze anti-vascular endothelial growth factor (anti-VEGF) agent-associated industry payments to ophthalmologists using the Centers for Medicare and Medicaid Services (CMS) Open Payments and Provider Utilization and Payment data.
  
  
  METHODS
  Retrospective database review using 2 national databases.
  
  
  METHODS
  Payments from 2013 to 2014 were analyzed by anti-VEGF agent, payment category, and dollar amount. Ranibizumab and aflibercept usage was correlated by performing log-ratio analysis.
  
  
  RESULTS
  A total of 3207 ophthalmologists received 13 449 payments totaling $4 454 325 associated with ranibizumab and aflibercept. As 7% of ophthalmologists received 90% of payments, the Gini index was 0.92, demonstrating unequal distribution of payments. Consulting fees and speaker fees were associated with highest payment amounts to fewest providers. For 2383 providers (74%), greater than 90% of the anti-VEGF payments were associated exclusively with either ranibizumab or aflibercept. A total of 1382 ophthalmologists were matched in both databases. Providers receiving >90% of payments from ranibizumab were more likely to use ranibizumab, and those receiving >90% of payments from aflibercept were more likely to use aflibercept over bevacizumab as compared to those who received no payments.
  
  
  CONCLUSIONS
  The distribution of all anti-VEGF payments is unequal. Ophthalmologists who received aflibercept or ranibizumab payments were more likely to receive the majority of payments from one source or the other, but not both. Those who received anti-VEGF payments were more likely to use ranibizumab or aflibercept, as compared to off-label bevacizumab, than those who did not receive any payment.
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Nakul
authors.initials: N
authors.lastname: Singh
authors.affiliation: Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Chang
authors.affiliation: Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio. Electronic address: rachita@ccf.org.
authors.forename: Aleksandra V
authors.initials: AV
authors.lastname: Rachitskaya
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000191:economics; D000068258:Bevacizumab / Q000008:administration & dosage* / Q000191:economics; D016208:Databases, Factual; D005260:Female; D005102:Health Expenditures; D006801:Humans; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000188:drug therapy* / Q000191:economics; D008297:Male; D000072163:Ophthalmologists / Q000191:economics*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage* / Q000191:economics; D012189:Retrospective Studies; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014792:Visual Acuity
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