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Fei Yu, Annie Wu, Connie Wu, Paul B Greenberg, Flora Lum, Anne Coleman; Variation in the use of bevacizumab and ranibizumab for branch retinal vein occlusion. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1507.
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© ARVO (1962-2015); The Authors (2016-present)
To describe frequency and variation of intravitreal bevacizumab and ranibizumab use for branch retinal vein occlusion (BVO) in the United States (US) with the aim of improving cost effective ophthalmic treatment utilization.
We obtained a 5% sample of Medicare beneficiaries from the Medicare Part B claims files from 2010 to 2013 and identified all beneficiaries with an ICD-9-CM code for branch retinal vein occlusion (BVO, 362.36). Patient age, gender, race, and Charlson Comorbidity Index (CCI) scores were collected. HSCPS codes for bevacizumab (J3590, J9035, and J3490) and for ranibizumab (J2778) were used to identify the mode of treatment for each patient. Patients who met the following criteria were excluded from this study: (1) patients who were under 65 years of age; (2) patients who did not reside in the 50 United States or the District of Columbia; and (3) patients who did not have Part-B coverage or with HMO coverage that was not processed by CMS. Patients were also excluded from the analysis if they did not receive either of the above two treatments or if they received both types of treatment. Geographic variation was examined by comparing injection frequencies across the nine US census divisions using Chi-squared analysis.
During 2010-2013, there were 3,944 BVO patients who met the inclusion criteria, and a majority of them received bevacizumab compared to ranibizumab (76.7% vs 23.3%). Most patients were aged 85-89 (22.0%), female (61.5%), white (88.3%), and had a CCI score of 1-2 (39.8%). The frequencies of bevacizumab and ranibizumab injections for BVO varied significantly between the US census divisions (p<0.0001). The highest frequencies of bevacizumab use were in the Mountain (90.6%) and Pacific (82.7%) divisions while the highest frequencies of ranibizumab use were in the West North Central (37.9%) and Mid Atlantic (32.7%) divisions.
A majority of Medicare beneficiaries with BVO received bevacizumab compared to ranibizumab, with significant geographic variation in the use of the two anti-VEGF agents. Future research into factors driving geographic variation in the use of these agents may help direct cost-effective strategies for the management of BVO.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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