Abstract
Purpose :
The use of intravitreal injections has reshaped the management of a number of chorioretinal conditions and are widely used by many ophthalmologists throughout the Unites States (US). Despite their effectiveness, they can be particularly costly to the several parties involved in their use. Using the Medicare Provider and Utilization Data Report (MPUDR), we aim to quantify the number and cost of intravitreal injections given to Medicare Part B beneficiaries from the most recent years available, 2012-2016, and project future trends in cost and utilization of intravitreal injections.
Methods :
The MPUDR was utilized to harvest data for all ophthalmology providers who performed intravitreal injections (67028 CPT code) in the years 2012-2016. For each year, data were collected on the number of injections performed, number of Medicare beneficiaries injected, intravitreal agent used, and Medicare reimbursement for each injection. Total number of intravitreal injections, cost per-injection, cost per-agent, and total cost to Medicare was determined. Linear regression utilizing the MPUDR data was used to project the number of intravitreal injections, cost per-injection, and total cost to Medicare for the year 2026.
Results :
From 2012-2016, the total number of intravitreal injections increased from 2,286,592 to 2,936,274 (R2 =0.98, p=0.001). Beneficiaries receiving injections also increased over the same time period, 533,792 to 691,454 (R2 =0.99, p<0.001). The Medicare cost per-beneficiary rose from $3,148 to $3,945 (R2 =0.92, p=0.03). The total cost to Medicare for intravitreal injections increased from $1.68 billion to $2.73 billion (R2 =0.99, p<0.005). In 2016, aflibercept cost $1.62 billion for Medicare, followed by ranibizumab at $0.78 billion, and bevacizumab at $66.8 million. In 2016, 42.6% of Medicare reimbursement to ophthalmology providers was spent on intravitreal injection therapy. At the current rate, the cost of intravitreal injections for Medicare beneficiaries will cost $5.25-$6.26 billion per-year by 2026.
Conclusions :
The total number of injections, Medicare beneficiaries being treated with intravitreal injections, and costs associated with intravitreal injections rose significantly from 2012-2016. Intravitreal injections represent a significant portion of all ophthalmology reimbursement from Medicare part B. This cost is projected to more than double by 2026 which rasies questions about current utilization.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.