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. 2019 Aug 1;137(8):921-928.
doi: 10.1001/jamaophthalmol.2019.1971.

Analysis of Anti-Vascular Endothelial Growth Factor Injection Claims Data in US Medicare Part B Beneficiaries From 2012 to 2015

Sean T Berkowitz  1 , Paul Sternberg Jr  1 , Xiaoke Feng  2 , Qingxia Chen  2 , Shriji Patel  1
Affiliations

Analysis of Anti-Vascular Endothelial Growth Factor Injection Claims Data in US Medicare Part B Beneficiaries From 2012 to 2015

Sean T Berkowitz et al. JAMA Ophthalmol. .

Abstract

Importance: The frequency of anti-vascular endothelial growth factor (VEGF) injections has grown exponentially with the introduction of bevacizumab, ranibizumab, and most recently aflibercept. The cost associated with these medications has garnered significant national attention, warranting a granular analysis of their use.

Objective: To analyze trends in anti-VEGF injections for US Medicare Part B beneficiaries from 2012 to 2015.

Design, setting, and participants: This observational cohort study used 2012-2015 data from the Centers for Medicare & Medicaid Services Medicare Part B Provider Utilization Files to analyze trends in intravitreal injections of anti-VEGF medications among Medicare Part B beneficiaries and their health care professionals.

Main outcomes and measures: The primary outcome measure was distribution of and change over time in the number of anti-VEGF injections performed for ranibizumab, aflibercept, and bevacizumab.

Results: A total of 2 574 124 intravitreal injections were performed by 3348 ophthalmologists in the outpatient setting for Medicare Part B beneficiaries during the 2015 calendar year; 100 ophthalmologists (3.0%) performed the highest volume of intravitreal injections. The total number of intravitreal injections administered in 2015 was 870 843 for aflibercept, 697 412 for ranibizumab, and 1 147 432 for bevacizumab. Ranibizumab injections decreased by 7.1% from 2012 to 2015 and bevacizumab injections decreased by 17.1%. From 2013 to 2015, aflibercept injections increased by 69.4%. The 100 ophthalmologists performing the highest volume of ranibizumab injections, as gauged by number of injections administered, accounted for 31.0% (95% CI, 30.994%-30.997%) of all ranibizumab injections nationally. The 100 ophthalmologists performing the highest volume of aflibercept injections accounted for 17.6% (95% CI, 17.638%-17.641%) of all aflibercept injections and the 100 ophthalmologists performing the highest volume of bevacizumab injections accounted for 19.6% (95% CI, 19.649%-19.653%) of all bevacizumab injections administered nationally to Medicare Part B beneficiaries. The highest number of injections per 1000 Medicare Part B beneficiaries occurred in Nebraska (aflibercept), Tennessee (ranibizumab), and South Dakota (bevacizumab).

Conclusions and relevance: A total of 3.0% of ophthalmologists account for 17.6% to 31.0% of the total number of anti-VEGF injections administered nationally in the Medicare Part B population. Overall, bevacizumab and ranibizumab injections have decreased, coinciding with a 69.4% increase in aflibercept injections.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Sternberg reported receiving personal fees from Nektar Therapeutics outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Proportion of National Aflibercept, Ranibizumab, and Bevacizumab Injections Performed in Medicare Part B Population in 2015 by 100 Ophthalmologists With Highest Volume of Injections
Figure 2.
Figure 2.. Geographical Distribution of Mean Number of Anti–Vascular Endothelial Growth Factor Injections per 1000 Medicare Part B Beneficiaries in 2015 for Aflibercept, Ranibizumab, and Bevacizumab
Figure 3.
Figure 3.. Distribution of Anti–Vascular Endothelial Growth Factor Drug Choice by 100 Ophthalmologists With Highest Volume of Injections for Aflibercept, Ranibizumab, and Bevacizumab
Figure 4.
Figure 4.. Trend in Number of Injections Administered Annually in Medicare Part B Population vs Percentage of Use by 100 Ophthalmologists With Highest Volume of Injections for Aflibercept, Ranibizumab, and Bevacizumab
See this image and copyright information in PMC

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