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Use of Bevacizumab and Ranibizumab for Wet Age-Related Macular Degeneration: Influence of CATT Results and Introduction of Aflibercept

  • Suzann Pershing
    Affiliations
    Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA

    Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
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  • Nidhi Talwar
    Affiliations
    Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA

    Center for Eye Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
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  • Stephen T. Armenti
    Affiliations
    Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
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  • Joseph Grubbs Jr.
    Affiliations
    Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
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  • Julie M. Rosenthal
    Affiliations
    Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
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  • Vaidehi S. Dedania
    Affiliations
    Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
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  • Joshua D. Stein
    Correspondence
    Inquiries to Joshua D. Stein, Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, 1000 Wall Street, Ann Arbor, MI 48105
    Affiliations
    Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA

    Center for Eye Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA

    Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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      Purpose

      To assess whether publication of Comparison of Age-related macular degeneration Treatment Trial (CATT) results and introduction of aflibercept to the marketplace affected intravitreal bevacizumab and ranibizumab utilization.

      Design

      Retrospective analysis of treatment patterns.

      Methods

      We calculated weekly bevacizumab and ranibizumab utilization during 3 timeframes: (1) before CATT publication, (2) between CATT publication (April 28, 2011) and assignment of a unique aflibercept billing code (January 1, 2013), and (3) afterward for 164,188 Medicare beneficiaries with neovascular macular degeneration receiving ≥1 anti–vascular endothelial growth factor injection(s) from January 1, 2008 to December 31, 2014. We identified ophthalmologists who predominantly (≥80%) administered bevacizumab or ranibizumab and evaluated changes in preferences over the 3 periods. We replicated analyses on 881,381 commercially insured beneficiaries.

      Results

      Among 317 ophthalmologists administering predominantly ranibizumab to Medicare beneficiaries pre-CATT, 221 (69.7%) reduced ranibizumab use post-CATT, whereas 96 (30.3%) continued using ranibizumab ≥80% of the time. Findings were reversed among 1041 ophthalmologists who predominantly administered bevacizumab pre-CATT—777 (74.6%) continued bevacizumab-predominant use while 264 (25.4%) reduced bevacizumab use post-CATT. Among the 145 ophthalmologists who predominantly administered ranibizumab before aflibercept's availability, 77 (53.1%) reduced ranibizumab utilization and 68 (46.9%) continued using ranibizumab ≥80% of the time after aflibercept became available. Corresponding numbers among the 909 ophthalmologists who predominantly administered bevacizumab pre-aflibercept were 381 (41.9%) reducing and 528 (58.1%) continuing bevacizumab-predominant use. Similar results were observed for commercially insured patients.

      Conclusions

      Many ophthalmologists who favored ranibizumab switched to bevacizumab after CATT publication, while most who favored bevacizumab before CATT publication continued favoring it afterward. Aflibercept's introduction had little impact on preferences for ranibizumab or bevacizumab.
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