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Annie Wu, Connie Wu, Paul B Greenberg, Fei Yu, Flora Lum, Anne Coleman; Variation in the use of bevacizumab and ranibizumab for diabetic macular edema. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2909.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the distribution of intravitreal bevacizumab and ranibizumab injections for diabetic macular edema (DME) in the United States (US) with the goal of improving cost-effective medication utilization.
A 5% sample of Medicare beneficiaries in the Carrier file (Part B Medicare claims file) was obtained to identify all beneficiaries with an ICD-9-CM code for DME (362.07) from 2010 to 2013. Patient characteristics including age, gender, and Charlson Comorbidity Index (CCI) were collected. HSCPS codes for bevacizumab (J3590, J9035, and J3490) and for ranibizumab (J2778) were used to identify the mode of treatment and associated billing and reimbursement amounts for each patient. Geographic variation was determined by comparing injection frequencies across the nine US census divisions using Chi-squared analysis.
The 2010-2013 sample included 5,290 Medicare beneficiaries with DME: 34.6% were aged 65-69, 53.7% were female, 78.8% were white, and 36.0% had a CCI score of ≥5. Overall, there was a greater frequency of bevacizumab use (86.4%) compared to ranibizumab use (13.6%) for the sample of 5,290 patients with DME. The highest frequencies of bevacizumab use were in the Mountain (92.2%), West South Central (91.7%) and East South Central (90.4%) divisions. The highest frequencies of ranibizumab use were in the Mid Atlantic (24.0%), West North Central (19.9%) and New England (16.6%) divisions. The frequencies of bevacizumab and ranibizumab injections for DME varied significantly between the US census divisions (p<0.0001).
Bevacizumab is used more frequently than ranibizumab for the treatment of DME among Medicare beneficiaries, with significant geographic variation in injection frequencies of the two anti-VEGF agents. Further characterization of the factors contributing to this variation may help direct cost-effective strategies for the management of DME.
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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