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Rachel Thakore, Paul B Greenberg, Dustin French, Jess J Behrens; Variation in Ophthalmologist Use of Anti-VEGF Therapy Among Medicare Beneficiaries. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3344.
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© ARVO (1962-2015); The Authors (2016-present)
The type of anti-vascular endothelial growth factor (anti-VEGF) therapies used by ophthalmologists can vary considerably, impacting the costs of care. Using the recently released Medicare physician utilization data, we analyzed geographic trends in the use of anti-VEGF therapy amongst ophthalmologists across a two-year period (2012-2013).
Using Healthcare Common Procedure Coding System codes, we identified ophthalmologists who billed for ranibizumab (J2778), bevacizumab (J9035), and aflibercept (J0178/Q2046) in the 2012 and 2013 Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use Files. We classified ophthalmologists to hospital referral regions (HRRs), urban/rural status, and Census regions using zip codes. We used ArcGIS (Redlands, CA, USA) to map the percentage of physicians in each HRR that used each anti-VEGF drug. We conducted chi-squared tests to determine 1) variation based on year, Census region, urban/rural status, and 2) geographic changes between 2012 and 2013.
The Figure shows geographic variation based on HRRs. Aflibercept was used by the least number of physicians in 2012 (57.0%; n=1359) but was the most widely used medication in 2013 (69.6%; n=1835). In the west, bevacizumab was used by more ophthalmologists (91.5%; n=606) than aflibercept (57.3%; n=379) and ranibizumab (52.4%; n=347). In the Midwest, more ophthalmologists used aflibercept (81.2%; n=423) and ranibizumab (77.0%; n=401) than bevacizumab (19.4%; n=101). There was significant variation in anti-VEGF drug use based on the year (p<0.0001), Census region (p<0.0001), and urban/rural status of the ophthalmologist (p<0.0001) [Table]. From 2012 to 2013, the number of ophthalmologists using bevacizumab increased from 9.9% (43/434) to 19.0% (95/500) in the Midwest and 84.3% (493/585) to 90.2% (573/635) in the west (p<0.001).
From 2012 to 2013, there was significant geographic variation in anti-VEGF drug use among ophthalmologists as well as significant changes in prescribing patterns. Further research is needed to identify the major determinants of this geographic variation and how these trends may impact future Medicare costs.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Anti-Vascular Endothelial Growth Factor Drug(s) Used by the Greatest Percentage of Ophthalmologists per Hospital Referral Regions, 2012/2013.
Variation in Anti-VEGF drugs by year, urban/rural status, and Census region
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