Neovascular age-related macular degeneration (NVAMD) and clinically-significant diabetic macular edema (CSDME) are two leading causes of blindness in the United States. Ranibizumab is a biologic drug shown to reverse the progression of these diseases and has seen rapid increases in use by ophthalmologists. Bevacizumab is a similar biologic used off-label for ophthalmologic use. Existing studies show these therapies to have similar efficacy and side-effect rates, but bevacizumab is forty times less expensive. The costs of these therapies are important for national policymaking because these two drugs together consume about one-sixth of the Medicare Part B drug budget.
Method:
We use a mathematical model of market adoption to project costs of these therapies over 10 years and examine alternative scenarios with different patterns of use of ranibizumab and bevacizumab. We also use models of ophthalmologic disease to examine health outcomes and the cost-effectiveness of using the different therapies.
Result:
At current practice patterns, we estimate over ten years Medicare will spend $16 billion on these therapies and patients will spend $4 billion on co-pays and supplemental insurance premiums to cover the costs of these drugs. If all patients switched to ranibizumab, costs to Medicare could jump to $47 billion and if patients switched to bevacizumab, costs would drop to $1.1 billion. Although ranibizumab may have slightly better health outcomes, they come at a cost of about $2 million per QALY. We find it may be possible to increase reimbursement for bevacizumab and yet lead to net cost savings to Medicare if some ophthalmologists switch from ranibizumab to bevacizumab.
Conclusion:
Changing treatment patterns with these two biologic drugs can save patients billions of dollars and have a major impact on Medicare’s long-term spending on physician-administered drugs. Although current regulations may make it difficult to restrict reimbursement for ranibizumab, creative policies like increasing bevacizumab reimbursement could lead to large cost savings for Medicare.