Estimating Medicare and Patient Savings From the Use of Bevacizumab for the Treatment of Exudative Age-related Macular Degeneration

Philip J. Rosenfeld, Matthew A. Windsor, William J. Feuer, Sissi J.J. Sun, Kevin D. Frick, Eric A. Swanson, David Huang

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose: The Medicare cost savings from the use of bevacizumab in the United States for the treatment of exudative age-related macular degeneration (AMD) were estimated by replacing the use of bevacizumab with ranibizumab and aflibercept. Design: Retrospective trend study. Methods: Main outcome measures were spending by Medicare as tracked by Current Procedural Terminology (CPT) codes for intravitreal injections (67028) and treatment-specific J-codes (J0178, J2778, J9035, J3490, and J3590) for inhibitors of vascular endothelial growth factor. These claims were identified from the Medicare Provider Utilization and Payment Data from the Centers for Medicare and Medicaid Services among fee-for-service (FFS) Medicare beneficiaries from 2012 to 2015. The 2008 claims were acquired from the 100% fee-for-service (FFS) Part B Medicare Claims File. Results: The use of bevacizumab from 2008 to 2015 resulted in an estimated savings of $17.3 billion, which corresponded to a $13.8 billion savings to Medicare and a $3.5 billion savings to patients. This amount underestimated the actual cost savings to Medicare providers, since approximately 30% of Medicare-eligible recipients received care within Medicare Advantage plans and were not included in this analysis. Conclusions: The cost savings from the use of bevacizumab from 2008 to 2015 for Medicare fee-for-service patients undergoing treatment for exudative AMD was estimated at $17.3 billion. Additional savings over the $17.3 billion would have accrued from the use of bevacizumab if diagnostic categories such as diabetic macular edema and retinal vein occlusion were included in this study.

Original languageEnglish (US)
Pages (from-to)135-139
Number of pages5
JournalAmerican Journal of Ophthalmology
Volume191
DOIs
StatePublished - Jul 1 2018

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Macular Degeneration
Medicare
Fee-for-Service Plans
Cost Savings
Therapeutics
Medicare Part B
Medicare Part C
Current Procedural Terminology
Centers for Medicare and Medicaid Services (U.S.)
Retinal Vein Occlusion
Intravitreal Injections
Macular Edema
Bevacizumab
Vascular Endothelial Growth Factor A
Retrospective Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Estimating Medicare and Patient Savings From the Use of Bevacizumab for the Treatment of Exudative Age-related Macular Degeneration. / Rosenfeld, Philip J.; Windsor, Matthew A.; Feuer, William J.; Sun, Sissi J.J.; Frick, Kevin D.; Swanson, Eric A.; Huang, David.

In: American Journal of Ophthalmology, Vol. 191, 01.07.2018, p. 135-139.

Research output: Contribution to journalArticle

Rosenfeld, Philip J. ; Windsor, Matthew A. ; Feuer, William J. ; Sun, Sissi J.J. ; Frick, Kevin D. ; Swanson, Eric A. ; Huang, David. / Estimating Medicare and Patient Savings From the Use of Bevacizumab for the Treatment of Exudative Age-related Macular Degeneration. In: American Journal of Ophthalmology. 2018 ; Vol. 191. pp. 135-139.
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abstract = "Purpose: The Medicare cost savings from the use of bevacizumab in the United States for the treatment of exudative age-related macular degeneration (AMD) were estimated by replacing the use of bevacizumab with ranibizumab and aflibercept. Design: Retrospective trend study. Methods: Main outcome measures were spending by Medicare as tracked by Current Procedural Terminology (CPT) codes for intravitreal injections (67028) and treatment-specific J-codes (J0178, J2778, J9035, J3490, and J3590) for inhibitors of vascular endothelial growth factor. These claims were identified from the Medicare Provider Utilization and Payment Data from the Centers for Medicare and Medicaid Services among fee-for-service (FFS) Medicare beneficiaries from 2012 to 2015. The 2008 claims were acquired from the 100{\%} fee-for-service (FFS) Part B Medicare Claims File. Results: The use of bevacizumab from 2008 to 2015 resulted in an estimated savings of $17.3 billion, which corresponded to a $13.8 billion savings to Medicare and a $3.5 billion savings to patients. This amount underestimated the actual cost savings to Medicare providers, since approximately 30{\%} of Medicare-eligible recipients received care within Medicare Advantage plans and were not included in this analysis. Conclusions: The cost savings from the use of bevacizumab from 2008 to 2015 for Medicare fee-for-service patients undergoing treatment for exudative AMD was estimated at $17.3 billion. Additional savings over the $17.3 billion would have accrued from the use of bevacizumab if diagnostic categories such as diabetic macular edema and retinal vein occlusion were included in this study.",
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AU - Sun, Sissi J.J.

AU - Frick, Kevin D.

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N2 - Purpose: The Medicare cost savings from the use of bevacizumab in the United States for the treatment of exudative age-related macular degeneration (AMD) were estimated by replacing the use of bevacizumab with ranibizumab and aflibercept. Design: Retrospective trend study. Methods: Main outcome measures were spending by Medicare as tracked by Current Procedural Terminology (CPT) codes for intravitreal injections (67028) and treatment-specific J-codes (J0178, J2778, J9035, J3490, and J3590) for inhibitors of vascular endothelial growth factor. These claims were identified from the Medicare Provider Utilization and Payment Data from the Centers for Medicare and Medicaid Services among fee-for-service (FFS) Medicare beneficiaries from 2012 to 2015. The 2008 claims were acquired from the 100% fee-for-service (FFS) Part B Medicare Claims File. Results: The use of bevacizumab from 2008 to 2015 resulted in an estimated savings of $17.3 billion, which corresponded to a $13.8 billion savings to Medicare and a $3.5 billion savings to patients. This amount underestimated the actual cost savings to Medicare providers, since approximately 30% of Medicare-eligible recipients received care within Medicare Advantage plans and were not included in this analysis. Conclusions: The cost savings from the use of bevacizumab from 2008 to 2015 for Medicare fee-for-service patients undergoing treatment for exudative AMD was estimated at $17.3 billion. Additional savings over the $17.3 billion would have accrued from the use of bevacizumab if diagnostic categories such as diabetic macular edema and retinal vein occlusion were included in this study.

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