A Cheaper But Effective Eye-Disease Drug

By Jane Farrell

Eye doctors could save billions in health-care costs if they prescribed a less expensive but effective drug to treat two common forms of serious eye disease in older adults.

Researchers from the University of Michigan focused on two medicines used to treat the wet form of macular degeneration and diabetic macular edema. Bevacizumab (marketed under the name Avastin) costs $55 per treatment and ranibizumab (trade name Lucentis) costs $2,023 for each dose—nearly 40 times more expensive.

The researchers also said patients would be saved $4.6 billion in co-pays, and the rest of the U.S. health care system could save $29 billion in private insurance payments and other costs. The drugs are similarly successful in treating the two eye illnesses.

The study, led by David Hutton, assistant professor of health management and policy at the U-M School of Public Health, was published in the journal Health Affairs.

“As the Medicare-eligible population continues to grow, identifying savings while maintaining quality patient care is increasingly important,” 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.”

Over two million people – most over the age of 65 – have the two illnesses. Experts estimate that by 2020 nearly three million people will have visual impairment due to age-related macular degeneration.

Earlier this year, the Centers for Medicare and Medicaid Services released statistics showing that 17,000 ophthalmologists collectively received $5.6 billion in Medicare payments in 2012. The largest percentage of the reimbursements was to cover the cost of ranibizumab.

In calculating the savings, the researchers used modeling methods to predict population-level costs for the decade spanning 2010-20 based on current use of the two drugs.

The differences in costs stem from the fact that bevacizumab originally was created as a cancer-fighting drug. For a number of years physicians have used bevacizumab to treat the 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 FDA as a drug targeted at these eye diseases. In doing so, the company attached the higher price to the new drug.