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Ranibizumab and bevacizumab are two of the most popular treatments for neovascular age-related macular degeneration (wet AMD). Both treatments are efficacious, but ranibizumab is much more expensive than bevacizumab.

Comparing Medicare reimbursements for the two drugs, ranibizumab is reimbursed at $2,023 per dose, while bevacizumab is reimbursed at $55 per dose. This cost can quickly add up, given the dosing frequency needed for wet AMD treatment. This study examines why a treatment option as expensive as ranibizumab is still used and how to promote economic equity for wet AMD treatment.

Bevacizumab is not FDA approved to treat wet AMD. However, it is still used more often than ranibizumab for this purpose. In 2008, there were 140,000 more injections of bevacizumab performed than ranibizumab. Critically, the usage of bevacizumab saves Medicare Part B beneficiaries hundreds of millions of dollars each year due to reduced reimbursement rates.

Studies comparing bevacizumab and ranibizumab have found no significant difference in their efficacy. Similarly, these two drugs are comparable in safety. Bevacizumab has a slightly higher risk of adverse vascular events, but these events would have to be 2.5 times higher for ranibizumab to be more cost-effective.

Surveys of retina specialists treating wet AMD found that cost-efficacy has been the primary factor for choosing bevacizumab over ranibizumab. Reasons for choosing ranibizumab were largely due to influences from industry and individual physician bias. Moreover, companies making ranibizumab have used rebate programs to encourage physicians to use it. Physician reimbursement for ranibizumab is about $66 in revenue per dose.

Based on these considerations, it is clear that the economic disparity caused by prescribing ranibizumab over bevacizumab is an industry-influenced issue. It is imperative that retina specialists are informed of this disparity so that they may practice cost-effectively [1].

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[1] Moreno, T. A., & Kim, S. J. (2016). Ranibizumab (Lucentis) versus Bevacizumab (Avastin) for the Treatment of Age-Related Macular Degeneration: An Economic Disparity of Eye Health. Seminars in Ophthalmology, 31(4), 378–384. https://doi.org/10.3109/08820538.2016.1154174