OIG: Avastin a Better Buy for Wet AMD

MedPageToday, 2012

WASHINGTON -- The Centers for Medicare and Medicaid Services (CMS) should establish a national payment policy for bevacizumab (Avastin) to treat wet age-related macular degeneration (AMD), a government report concluded.
Although bevacizumab, a cancer drug, is not approved to treat wet AMD, ophthalmologists nonetheless use it off-label to treat the condition, which is a leading cause of vision loss in people ages 60 and older.
A of bevacizumab and ranibizumab (Lucentis) -- which is FDA-approved for wet AMD -- confirmed that the two drugs differ little in preserving visual acuity.
Both drugs -- which are injected in a doctor's office -- are manufactured by Genentech, but ranibizumab injections cost over $1,900 each while bevacizumab costs only $26 per shot, according to a study issued Monday by the Department of Health and Human Services Office of the Inspector General (OIG).
OIG used Medicare claims data to identify 160 doctors who received Medicare payments for prescribing ranibizumab for wet AMD and 160 physicians who prescribed bevacizumab.
On average, doctors paid $1,928 per vial of ranibizumab in the first quarter of 2010, and were reimbursed by Medicare for $2,023 per dose.
By contrast, physicians paid an average of $26 per dose of bevacizumab, which included the costs of having larger doses of the cancer drug broken down into smaller doses for wet AMD, and the average Medicare reimbursement for bevacizumab in 2010 was $55 per dose.
Medicare beneficiaries pay approximately $400 in coinsurance for each dose of ranibizumab compared with approximately $11 in coinsurance for each dose of bevacizumab, the OIG investigators said.
Most physicians (70%) said it was because of cost, 45% said efficacy/effectiveness was a reason, and 40% said patient insurance coverage played a role in their decision.
One physician made the following comment: "I believe that Avastin works as well if not better than Lucentis.
Why would I not want to save expenses for my patients, our society, and government by using a product I believe is as effective as the incredibly more expensive alternative? My personal income would have been higher if I had used Lucentis, but I do not believe that is the right thing to do."