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Stephen T. Armenti, Joseph Grubbs, Vaidehi Dedania, Nidhi Talwar, Julie M Rosenthal, Suzann Pershing, Joshua D Stein; Have the CATT Trial Results and Introduction of Aflibercept to the Marketplace Influenced Utilization of Bevacizumab and Ranibizumab for Retinal Diseases?. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5069.
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Using a large national database, we sought to determine whether the publication of the landmark CATT study results and the recent availability of aflibercept have affected utilization of bevacizumab and ranibizumab.
Using a healthcare claims database containing a 20% sample of all Medicare enrollees with Parts A, B, and D coverage, we identified all enrollees who had received anti-VEGF injections each week from 1/1/08 to 12/31/14. We were interested in bevacizumab and ranibizumab during 3 time periods: Period 1 was the timeframe prior to dissemination of the CATT results (1/1/08 to 4/27/11), Period 2 was the timeframe following the dissemination of the CATT results and prior to aflibercept receiving its own CPT code (4/28/11 to 12/31/12) and Period 3 was the timeframe after aflibercept received its own code (1/1/13 to 12/31/14). We compared trends in anti-VEGF utilization during each period. Our analyses were replicated using a dataset of enrollees with commercial health insurance.
There was a dramatic increase in total anti-VEGF injections from 2008 (avg. 3328 inj/wk) to 2014 (avg. 8957 inj/wk). The rate of bevacizumab use increased by 14 inj/wk during Period 1, largely stabilized during Period 2 with an increase of 0.6 inj/wk, and decreased during Period 3 by 2.2 inj/wk. By comparison ranibizumab use increased 7.8 inj/wk during Period 1, decreased in Period 2 by 4.6 inj/wk and continued to decrease in Period 3 by 1.7 inj/wk. The difference in slope for period 1 compared to periods 2 and 3 for both agents was statistically significant (p<0.001 for all), whereas the slope from Period 2 was not significantly different than Period 3 (p=0.39 for bevacizumab, p=0.09 for ranibizumab). Interestingly, the largest difference in injections between bevacizumab and ranibizumab occurred in the week starting 6/5/12 (5894 vs. 2227 inj/wk), 4 weeks after the 2 year CATT trial results were released.
Ophthalmologists’ decisions of which anti-VEGF agent to use appear to be influenced by the results of large clinical trials such as the CATT Trial, as ranibizumab use decreased following its dissemination. Furthermore, the addition of aflibercept to the marketplace appears associated with reductions in the use of bevacizumab and ranibizumab.
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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