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Member Research and Reports

Member Research and Reports

Michigan Study Finds Choosing One Drug over Another to Treat Blindness Could Save Medicare Billions

If all eye doctors prescribed the less expensive of two drugs to treat two common eye diseases of older adults, taxpayer-funded Medicare plans could save $18 billion over a 10-year period, say researchers at the University of Michigan. Further, patients with the wet form of macular degeneration or who have diabetic macular edema could keep $4.6 billion in co-pays in their wallets, and the rest of the U.S. health care system could save $29 billion in private insurance payments and other costs, according to the team led by Dr. David Hutton, assistant professor at the University of Michigan School of Public Health.

The reason for the dramatic savings: bevacizumab (marketed under the name Avastin) costs $55 per treatment and ranibizumab (trade name Lucentis) runs $2,023 for each dose – nearly 40 times more expensive. Yet, the drugs have similar efficacy in treating these conditions, and both have fairly comparable side effect and safety profiles when used to treat eye disease, the researchers say.

“As the Medicare-eligible population continues to grow, identifying savings while maintaining quality patient care is increasingly important,” Dr. Hutton said. “People don’t like to think there are tradeoffs between health and costs but we certainly do need to think about cost when health care is 18 percent of the GDP and growing.”

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, is featured in Health Affairs. It comes on the heels of a national debate over data released in April 2014 by the Centers for Medicare and Medicaid Services, showing that 17,000 ophthalmologists collectively received $5.6 billion in Medicare payments in 2012. The report showed that ophthalmologists had some of the highest payment totals among physicians, and the largest percentage of the reimbursements to these specialists was to cover the cost of ranibizumab.