Switching to less expensive blindness drug could save medicare part B $18 billion over a ten-year period

Health Affairs

Volumn 33, Issue 6, 2014, Pages 931-939

  Hutton, David ^a   Newman Casey, Paula Anne ^b   Tavag, Mrinalini ^a   Zacks, David ^b   Stein, Joshua ^b  

^a UNIVERSITY OF MICHIGAN   (United States)

^b UNIVERSITY OF MICHIGAN MEDICAL SCHOOL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

BEVACIZUMAB; RANIBIZUMAB; MONOCLONAL ANTIBODY;

ARTICLE; BLINDNESS; CEREBROVASCULAR ACCIDENT; COST CONTROL; DIABETIC MACULAR EDEMA; DRUG COST; DRUG SUBSTITUTION; HEALTH CARE; HEALTH INSURANCE; HEART INFARCTION; HUMAN; MATHEMATICAL MODEL; MEDICARE; PREDICTION; RETINA MACULA AGE RELATED DEGENERATION; TREATMENT OUTCOME; VENOUS THROMBOEMBOLISM; COMPARATIVE STUDY; DIABETIC RETINOPATHY; ECONOMICS; MACULAR DEGENERATION; MACULAR EDEMA; STATISTICS AND NUMERICAL DATA; UNITED STATES;

ANTIBODIES, MONOCLONAL, HUMANIZED; BEVACIZUMAB; BLINDNESS; COST SAVINGS; DIABETIC RETINOPATHY; DRUG COSTS; DRUG SUBSTITUTION; HUMANS; MACULAR DEGENERATION; MACULAR EDEMA; MEDICARE PART B; RANIBIZUMAB; UNITED STATES;

EID: 84902009122     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2013.0832     Document Type: Article

References (53)

1. Hussey PS, Eibner C, Ridgely MS, McGlynn EA. Controlling U.S. health care spending-separating promising from unpromising approaches. N Engl J Med. 2009;361(22): 2109-11.
2. Pollack A. Costly drugs known as biologics prompt exclusivity debate. New York Times. 2009 Jul 21.
3. Schmucker C, Ehlken C, Agostini HT, Antes G, Ruecker G, Lelgemann M, et al. A safety review and metaanalyses of bevacizumab and ranibizumab: off-label versus goldstandard. PLoS One. 2012;7(8):e42701.
4. Department of Health and Human Services, Office of Inspector General. Review of Medicare Part B Avastin and Lucentis treatments for agerelated macular degeneration. Washington (DC): HHS; 2011 Sep 6.
5. Department of Health and Human Services, Office of Inspector General. Medicare payments for drugs used to treat wet age related macular degeneration. Washington (DC): HHS; 2012 Apr 20.
6. Zhang X, Saaddine JB, Chou CF, Cotch MF, Cheng YJ, Geiss LS, et al. Prevalence of diabetic retinopathy in the United States, 2005-2008. JAMA. 2010;304(6):649-56.
7. Friedman DS, O'Colmain BJ, Muñoz B, Tomany SC, McCarty C, deJong PT, et al. Prevalence of age-related macular degeneration in the United States. Arch Ophthalmol. 2004; 122(4):564-72.
8. Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, et al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006;355(14):1419-31.
9. Brown DM, Kaiser PK, Michels M, Soubrane G, Heier JS, Kim RY, et al. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med. 2006; 355(14):1432-44.
10. Nguyen QD, Brown DM, Marcus DM, Boyer DS, Patel S, Feiner L, et al. Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology. 2012; 119(4):789-801.
11. Chakravarthy U, Harding SP, Rogers CA, Downes SM, Lotery AJ, Culliford LA, et al. Alternative treatments to inhibit VEGF in age-related choroidal neovascularisation: 2-year findings of the IVAN randomised controlled trial. Lancet. 2013; 382(9900):1258-67.
12. Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) Research Group, Martin DF, Maguire MG, Fine SL, Ying GS, Jaffe GJ, et al. Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results. Ophthalmology. 2012;119(7):1388-98.
13. Virgili G, Parravano M, Menchini F, Brunetti M. Antiangiogenic therapy with anti-vascular endothelial growth factor modalities for diabetic macular oedema. Cochrane Database Syst Rev. 2012;12:CD007419.
14. Whoriskey P, Keating D. An effective eye drug is available for $50. But many doctors choose a $2,000 alternative. Washington Post. 2013 Dec 7.
15. Stein JD, Newman-Casey PA, Kim DD, Nwanyanwu KH, Johnson MW, Hutton DW. Cost-effectiveness of various interventions for newly diagnosed diabetic macular edema. Ophthalmology. 2013;120(9): 1835-42.
16. Stein JD, Newman-Casey PA, Mrinalini T, Lee PP, Hutton DW. Cost-effectiveness of bevacizumab and ranibizumab for newly diagnosed neovascular macular degeneration. Ophthalmology. 2014; 121(4):936-45.
17. Raftery J, Clegg A, Jones J, Tan SC, Lotery A. Ranibizumab (Lucentis) versus bevacizumab (Avastin): modelling cost effectiveness. Br J Ophthalmol. 2007;91(9):1244-6.
18. Patel JJ, Mendes MA, Bounthavong M, Christopher ML, Boggie D, Morreale AP. Cost-utility analysis of bevacizumab versus ranibizumab in neovascular age-related macular degeneration using a Markov model. J Eval Clin Pract. 2012;18(2):247-55.
19. Pershing S, Enns EA, Matesic B, Owens DK, Goldhaber-Fiebert JD. Cost-effectiveness of treatment of diabetic macular edema. Ann Intern Med. 2014;160(1):18-29.
20. National Advisory Eye Council. Vision research, a national plan, 1994-1998. Bethesda (MD): National Institutes of Health, National Eye Institute; 1993.
21. Klein R, Klein BE, Linton KL. Prevalence of age-related maculopathy. The Beaver Dam Eye Study. Ophthalmology. 1992;99(6):933-43.
22. Saaddine JB, Honeycutt AA, Narayan KM, Zhang X, Klein R, Boyle JP. Projection of diabetic retinopathy and other major eye diseases among people with diabetes mellitus: United States, 2005-2050. Arch Ophthalmol. 2008;126(12):1740-7.
23. Centers for Medicare and Medicaid Services [Internet]. Baltimore (MD): CMS; 2014. Press release, Historic release of data gives consumers unprecedented transparency on the medical services physicians provide and how much they are paid; 2014 Apr 9 [cited 2014 Apr 16]. Available from: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Pressreleases/2014-Press-releases-items/2014-04-09.html
24. Whoriskey P, Keating D, Sun LH. Data uncover nation's top Medicare billers. Washington Post. 2014 Apr 9.
25. Pollack A, Abelson R. Eye doctors say their profits are smaller than data makes them look. New York Times. 2014 Apr 9.
26. To access the Appendix, click on the Appendix link in the box to the right of the article online.
27. Census Bureau. 2012 national population projections [Internet]. Washington (DC): Census Bureau; 2012 [cited 2014 Apr 9]. Available from: http://www.census.gov/population/projections/data/national/2012.html
28. Centers for Disease Control and Prevention. Percentage of civilian, noninstitutionalized population with diagnosed diabetes, by age, United States, 1980-2011 [Internet]. Atlanta (GA): CDC; 2013 [cited 2013 Apr 4]. Available from: http://www.cdc.gov/diabetes/statistics/prev/national/figbyage.htm
29. Rein DB, Wittenborn JS, Zhang X, Honeycutt AA, Lesesne SB, Saaddine J, et al. Forecasting age-related macular degeneration through the year 2050: the potential impact of new treatments. Arch Ophthalmol. 2009;127(4):533-40.
30. Varma R, Fraser-Bell S, Tan S, Klein R, Azen SP, Los Angeles Latino Eye Study Group. Prevalence of agerelated macular degeneration in Latinos: the Los Angeles Latino Eye Study. Ophthalmology. 2004;111(7): 1288-97.
31. Klein R, Klein BE, Knudtson MD, Wong TY, Cotch MF, Liu K, et al. Prevalence of age-related macular degeneration in 4 racial/ethnic groups in the Multi-Ethnic Study of Atherosclerosis. Ophthalmology. 2006;113(3):373-80.
32. Stein JD, Hanrahan BW, Comer GM, Sloan FA. Diffusion of technologies for the care of older adults with exudative age-related macular degeneration. Am J Ophthalmol. 2013; 155(4):688-96.
33. Curtis LH, Hammill BG, Qualls LG, DiMartino LD, Wang F, Schulman KA, et al. Treatment patterns for neovascular age-related macular degeneration: analysis of 284,380 Medicare beneficiaries. Am J Ophthalmol. 2012;153(6):1116-24.
34. Ruttan VW. What happened to technology adoption-diffusion research? Sociologia Ruralis. 1996;36(1): 51-73.
35. Diabetic Retinopathy Clinical Research Network, Elman MJ, Aiello LP, Beck RW, Bressler NM, Bressler SB, et al. Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology. 2010; 117(6):1064-1077 e1035.
36. Grunwald JE, Daniel E, Huang J, Ying GS, Maguire MD, Toth CA, et al. Risk of geographic atrophy in the comparison of age-related macular degeneration treatments trials. Ophthalmology. 2014;121(1): 150-61.
37. Centers for Medicare and Medicaid Services, Office of the Actuary. National health expenditure projections 2011-2021 [Internet]. Baltimore (MD): CMS; 2011 [cited 2013 May 1]. Available from: http://www.cms.gov/Research-Statistics-Dataand-Systems/Statistics-Trends-and-Reports/NationalHealthExpend Data/Downloads/Proj2011PDF.pdf
38. Gold MR, Siegel JE, Russell LB, Weinstein MC, editors. Costeffectiveness in health and medicine. New York (NY): Oxford University Press; 1996.
39. Diez Roux AV. Complex systems thinking and current impasses in health disparities research. Am J Public Health. 2011;101(9):1627-34.
40. Sterman JD. Business dynamics: systems thinking and modeling for a complex world. Boston (MA): McGraw-Hill; 2000.
41. Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr. 2010;8:29.
42. Yokota F, Thompson KM. Value of information literature analysis: a review of applications in health risk management. Med Decis Making. 2004;24(3):287-98.
43. Megerlin F, Lopert R, Taymor K, Trouvin JH. Biosimilars and the European experience: implications for the United States. Health Aff(Millwood). 2013;32(10):1803-10.
44. United States Patent and Trademark Office. Patent terms extended under 35 USC sect 156 [Internet]. Alexandria (VA): USPTO; 2012 [cited 2013 May 1]. Available from: http://www.uspto.gov/patents/resources/terms/156.jsp
45. Elman MJ, Bressler NM, Qin H, Beck RW, Ferris FL 3rd, Friedman SM, et al. Expanded 2-year follow-up of ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology. 2011; 118(4):609-14.
46. Elmendorf DW. CBO's analysis of the major health care legislation enacted in March 2010. Washington (DC): Congressional Budget Office; 2011.
47. Social Security Administration. Monthly statistical snapshot, March 2014 [Internet]. Washington (DC): Social Security Administration; 2014 [cited 2014 Apr 16]. Available from: http://www.ssa.gov/policy/docs/quickfacts/stat_snapshot/
48. Radley DC, Finkelstein SN, Stafford RS. Off-label prescribing among office-based physicians. Arch Intern Med. 2006;166(9):1021-6.
49. Harrison C. Enbrel patent surfaces. Nat Biotechnol. 2012;30(2):123.
50. Analysis Group. Biologics, biosimilars, and generics [Internet]. Boston (MA): Analysis Group; 2010 [cited 2013 Apr 23]. Available from: http://www.analysisgroup.com/anticipating_biosimilar_challenge.aspx
51. Drugs.com. Avastin sales data [Internet]. Auckland (NZ): Drugsite Trust; 2013 [cited 2014 Jan 29]. Available from: http://www.drugs.com/stats/avastin
52. Mantone J. Genentech, eye docs make peace on Avastin. WSJ Health Blog [blog on the Internet]. 2007 Dec 20 [cited 2014 Apr 25]. Available from: http://blogs.wsj.com/health/2007/12/20/genentech-eye-docsmake-peace-on-avastin/
53. US Senate Special Committee on Aging. A prescription for savings: reducing drug costs to Medicare, hearing, July 21, 2011 (Serial 112-7). Washington (DC): US Government Printing Office; 2011 Jul 21.