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Factors driving prescription decisions for macular degeneration complex – and costly

5197694152_fbbfe73c21_zFor the last decade or so of her life, my grandma was basically blind. Her eyes, like those of many seniors, suffered from macular degeneration, a progressive disorder that affects the macula, a small spot near center of the retina critical for clear vision.

She lived her last years in a nursing home in Iowa and I honestly don't know what drugs, if any, she took for this condition, much less how much they cost.

But multiplied by millions (macular degeneration is the most common cause of visual impairment in older adults), the costs are a big deal. That's why Stanford researchers set out to understand why doctors would prescribe one drug, ranibizumab (let's call it r) at a cost of $2,000 a dose over bevacizumab (b), which runs $50 a dose.

They published their findings in Health Affairs today.

Both drugs are equally effective and have similarly severe side effects. And, according to a 2011 report, if all Medicare doctors had prescribed b rather than r in 2011, the system would have saved $1.1 billion.

Stanford researchers hypothesized that Medicare physicians — who face a financial incentive to prescribe more expensive drugs — would be more inclined to prescribe r than Veterans Affairs physicians, who don't have the same incentive.

Instead, as health economist Kate Bundorf, PhD, told me, it's much more complex.

From our release:

Researchers examined data from both systems from 2005-11. In 2011, Medicare physicians prescribed the less costly bevacizumab (brand name Avastin) 63 percent of the time. Ranibizumab (Lucentis) was prescribed 37 percent of the time....

In the VA system, ranibizumab was prescribed 52 percent of the time in 2011. Interestingly, however, prescription decisions at the VA varied regionally, with some centers prescribing primarily bevacizumab, others primarily ranibizumab, and others alternating between the two drugs.

Bundorf has a couple of theories to account for the differences.

... Patients' financial incentives may also be influencing prescribing decisions - that is, they may be asking for the less expensive drug, particularly if they're covered by Medicare, whose patient co-pays sometimes reflect the cost of the drugs. Some physicians may also be thinking of the systemwide effects when selecting the less expensive drug, she said.

She urges both systems to reform their incentives to both serve patients and save money.

Previously: New way to predict advance of age-related macular degeneration, To maintain good eyesight, make healthy vision a priority and Competition keeps health-care costs low, Stanford study finds 
Photo by Michael Gil 

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