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Intravitreal Anti–Vascular Endothelial Growth Factor Cost Savings Achievable with Increased Bevacizumab Reimbursement and Use

      Purpose

      To model Medicare Part B and patient savings associated with increased bevacizumab payment and use for intravitreal anti–vascular endothelial growth factor (VEGF) therapy.

      Design

      Cost analysis.

      Participants

      Intelligent Research in Sight (IRIS®) Registry data.

      Methods

      Medicare claims and IRIS® Registry data were used to calculate Medicare Part B expenditures and patient copayments for anti-VEGF agents with increasing reimbursement and use of bevacizumab relative to ranibizumab and aflibercept.

      Main Outcome Measures

      Medicare Part B costs and patient copayments for anti-VEGF agents in the Medicare fee-for-service population.

      Results

      Increasing bevacizumab reimbursement to $125.78, equalizing the dollar margin with aflibercept, would result in Medicare Part B savings of $468 million and patient savings of $119 million with a 10% increase in bevacizumab market share.

      Conclusions

      Increased use of bevacizumab achievable with increased reimbursement to eliminate the financial disincentive to its use would result in substantial savings for the Medicare Part B program and for patients receiving anti-VEGF intravitreal injections.

      Abbreviations and Acronyms:

      ASP (average sales price), DME (diabetic macular edema), FFS (fee-for-service), IRIS® (Intelligent Research in Sight), MAC (Medicare administrative contractor), nAMD (neovascular age-related macular degeneration), PCV (polypoidal choroidal vasculopathy), RVO (retinal vascular occlusion), VEGF (vascular endothelial growth factor)
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