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Targeted Management of Excess Specialty Spending: The Case of Biologics for Retinal Disease

  • Helena Moon, MD,
  • Julian A. Mitton, MD, MPH,
  • Amanda Redmond, MBA, and
  • Nicholas Stine, MD
Published April 20, 2022
NEJM Catalyst Innovations in Care Delivery 2022; 05
DOI:https://doi.org/10.1056/CAT.21.0375
Vol. 3 No. 5 | May 2022
Summary

Injectable biologics used for the treatment of retinal disease offer a strong use case for ACOs, payers, and policy makers as they seek to manage total costs by reducing costly practice variation and avoidable Medicare Part B drug spending. Bevacizumab, which was originally approved by the U.S. FDA in 2004 for the systemic treatment of advanced colon cancer, has seen increased off-label utilization as a vascular endothelial growth factor (VEGF) inhibitor for retinal disease. Three anti-VEGF medications that are commonly used for retinal disease each have similar outcomes in clinical trials but have notably different average costs (in USD) per injection: bevacizumab, $90; ranibizumab, $1,883; and aflibercept, $2,098. Based on these and other factors, leaders at CommonSpirit Health, a large national nonprofit health system operating in 21 states, propose and model a reduction of clinical practice variation to a standard of care for this single indication to represent a $2.3 billion annual savings opportunity for Medicare.

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