Choosing One Drug Over Another to Treat Blindness Could Save Medicare Billions
Targeted News Service |
If all eye doctors prescribed the less expensive of two drugs to treat two common eye diseases of older adults, taxpayer-funded
Further, patients with the wet form of macular degeneration or who have diabetic macular edema could keep
The reason for the dramatic savings: bevacizumab (marketed under the name Avastin) costs
"As the
More than 2 million patients--most over the age of 65--currently have these eye diseases, and it is estimated that by 2020 nearly 3 million people will experience visual impairment from age-related macular degeneration.
The team's report, featured in the June issue of Health Affairs, comes on the heels of a national debate over data released in
In 2010, federal spending on the two drugs totaled
To calculate the savings, the researchers used sophisticated modeling methods to predict population-level costs for the decade spanning 2010-20 based on current use of the two drugs.
So why is one drug so much more costly?
Bevacizumab originally was created as a cancer-fighting drug, given in much higher doses to slow the development of blood vessels, thereby inhibiting the growth of tumors. In diabetic macular edema and one form of macular degeneration, it is the abnormal growth of blood vessels in the retina that causes blindness. Used in the eye, the medication targets the bleeding and swelling that occurs in the retina and shrinks the blood vessels, says study co-author Dr.
For a number of years physicians have used bevacizumab to treat these eye conditions off label, meaning prescribed for a use other than the one originally intended. In its full dose for cancer treatment (at 150 times the concentration of the ocular injections), the drug is more expensive, but the cost goes down when reduced to smaller doses for the eye.
The same drug company that manufactured bevacizumab created ranibizumab, which was approved by the
Both are in a class known as biologic drugs, which are large complex molecules manufactured within living cells and are costly to develop and manufacture.
"These relatively new drugs, the first available beginning in the mid-2000s, have revolutionized treatment for these eye diseases," Stein said. "Not only have they prevented vision from getting worse for many patients, a number of patients have seen an improvement in their vision."
Today, about two-thirds of eye doctors prescribe bevacizumab. Because it was tested and approved by the
"In two large clinical trials that have been done on use in eye disease, the data did not show a difference in rates of serious side effects, but those studies didn't have enough power to fully address safety," he said.
The researchers want their analysis to capture the attention of health policymakers.
"I hope that this study raises awareness of the rest of the medical community, sheds light on the issue of the cost of biologic drugs, and brings attention to how long it takes to get biosimilars (generic versions) of these drugs approved," Hutton said.
Other authors include:
Hutton, Stein and Newman-Casey are members of the
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