Community-Level Variation in On-Label Versus Off-Label Anti-VEGF Use and Medicare Part B Spending

Area of Science:

• Ophthalmology
• Health Economics
• Health Services Research

Background:

• Anti-VEGF agents are crucial for treating retinal diseases.
• Medicare Part B covers these treatments, with varying on-label vs. off-label usage.
• Understanding sociodemographic influences on treatment patterns is vital for equity.

Purpose of the Study:

• To investigate associations between community sociodemographics and the use of on-label versus off-label anti-VEGF agents in Medicare Part B.
• To estimate the financial impact of differing anti-VEGF agent mixes across communities.

Main Methods:

• Analysis of Medicare Part B claims data (2013-2023) for anti-VEGF injections.
• Generation of 15-minute drive-time service areas linked to U.S. Census tract sociodemographic data.
• Multivariable logistic regression and counterfactual simulations to assess sociodemographic effects and spending.

Main Results:

• Over 34.5 million anti-VEGF injections were analyzed from 5,178 providers.
• Higher on-label anti-VEGF use was linked to communities with higher proportions of Medicare-aged, Black/African American, and college-educated residents.
• Lower on-label use was associated with higher proportions of very low-income residents, potentially saving $4.2 billion if disparities were addressed.

Conclusions:

• Significant community-level disparities in on-label anti-VEGF agent use exist within Medicare Part B, despite uniform reimbursement.
• These disparities raise concerns about access, equity, and the value of care provided.
• Addressing these gradients could lead to substantial cost savings and improved healthcare equity.