Prescribing habits and cost models surrounding anti-VEGF therapy for eye disease were profoundly and, it seems, permanently changed by the work of Bascom Palmer retina specialist Philip Rosenfeld, MD, who in 2005 recognized that the intravenous cancer therapy Avastin (bevacizumab, Genentech) could be reconstituted for intravitreal use.1 His seminal paper on the concept effectively pulled the rug out from under its manufacturer just as the company was readying Lucentis (ranibizumab) for launch. 

In a new study published in American Journal of Ophthalmology, Dr. Rosenfeld shares the results of a retrospective review of Medicare payments for anti-VEGF therapy in eye care.2 “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,” the report states. “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.”

Main outcome measures were spending by Medicare during the study period as tracked by Current Procedural Terminology codes for intravitreal injections (67028) and treatment-specific J-codes (J0178, J2778, J9035, J3490 and J3590) for inhibitors of vascular endothelial growth factor. 

This analysis was limited to anti-VEGF use in treating wet age-related macular degeneration. Anti-VEGF agents are also used for diabetic macular edema and retinal vein occlusion; counting Avastin use for those indications would have increased the savings as well. Furthermore, as the study period represents only eight of the 13 years since the 2005 paper, the true savings is likely to be well over the $17 billion reported here.

1. Rosenfeld, PJ, Moshfeghi, AA, Puliafito, CA. Optical coherence tomography findings after an intravitreal injection of bevacizumab (avastin) for neovascular age-related macular degeneration. Ophthalmic Surg Lasers Imaging. 2005;36:331–335.
2. Rosenfeld PJ, Windsor MA, Feuer WJ, et al. Estimating Medicare and patient savings from the use of bevacizumab for the treatment of exudative age-related macular degeneration. Am J Ophthalmol [ePub ahead of print.]