OBJECTIVES

DR is the leading cause of blindness among working-age adults in the US. Recent studies have shown intravitreal injection with anti-VEGF inhibitors such as RAN and BEV was more effective in reversing neovascularization than traditional photocoagulation. RAN was approved for use in DME (2012), DR with DME (2015), and all forms of DR (2017). Though BEV is indicated for cancer only, ophthalmologists often repackage and use off-label to treat DR/DME. This study evaluated use of RAN and BEV in DR/DME.

METHODS

Patients were classified as incident DR/DME using ICD9/10-CM codes from the Symphony administrative claims database from 2013 to 2016. BEV and RAN were captured using HCPCS and NDC codes; index injection occurred within 60 days of diagnosis. Patients were free of BEV-indicated malignancies, and none had medication administered by an oncologist. Cardiovascular (CV) conditions such as stroke were evaluated three months prior to index injection since BEV and RAN can exacerbate these symptoms. Non-proliferative (NPDR) or proliferative diabetic retinopathy (PDR), treatment switch, presence of DME, and billed amounts for index injection were also evaluated.

RESULTSp = 0.01) and DME (79.1% vs 49.8%, p < 0.01) patients were prescribed more RAN than BEV. RAN had higher mean billed amounts than BEV ($2314.90 vs $190.29, p < 0.01). BEV experienced fewer treatment switches (5.1% vs 15.1%, p < 0.01) compared to RAN. CV comorbidities, concomitant photocoagulation, patient demographics, insurance type, and provider region had no effect on treatment.

CONCLUSIONS

Providers use anti-VEGF inhibitors regardless of approval status to treat ophthalmic conditions involving the retina. However, BEV appears to be the better value and further research on whether these savings translates to better ophthalmic outcomes is warranted.