The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Ophthalmology, University of California, San Francisco, San Francisco.
JAMA Ophthalmol. 2023 Sep 1;141(9):844-851. doi: 10.1001/jamaophthalmol.2023.3389.
Sustained-release corticosteroids offer the potential of improved compliance and greater patient convenience for anti-inflammatory treatment after cataract surgery. However, they are substantially more expensive than postoperative corticosteroid eye drops, which have historically been standard care.
To examine the use and cost of sustained-release corticosteroids in patients with Medicare who underwent cataract surgery in the US during the temporary pass-through reimbursement program period.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study examined Medicare fee-for-service (FFS) claims from beneficiaries with at least 12 continuous months of Medicare enrollment who underwent at least 1 cataract surgery from March 2019 through December 2021. Patients younger than 65 years, those with missing demographic information, those who had more than 1 cataract surgery on each eye, and those who received more than 1 corticosteroid on the day of surgery were excluded. Cataract surgeries with concurrent use of dexamethasone intraocular suspension 9% or dexamethasone ophthalmic insert were identified. Information on surgeon demographic characteristics and costs of surgery and drugs were extracted. Data were analyzed from June 15 to December 4, 2022.
Use of dexamethasone intraocular suspension 9% or dexamethasone ophthalmic insert during cataract surgery.
Utilization rate and cost of dexamethasone intraocular suspension 9% and dexamethasone ophthalmic insert among Medicare FFS beneficiaries who underwent cataract surgery.
A total of 4 252 532 cataract surgeries in Medicare FFS beneficiaries (mean [SD] age, 74.8 [5.8] years; 1 730 811 male [40.7%] and 2 521 721 female [59.3%]) were performed by 12 284 ophthalmologists (8876 male [72.3%], 2877 female [23.4%], and 531 sex unknown [4.3%]). In all, 34 627 beneficiaries (0.8%) received dexamethasone intraocular suspension 9% and 73 430 (1.7%) received a dexamethasone ophthalmic insert; the use of both drugs increased over the study period. The mean (SD) Medicare allowed charges for dexamethasone intraocular suspension 9% and dexamethasone ophthalmic insert were $531.47 ($141.52) and $538.49 ($63.79), respectively.
Despite offering the potential of improved compliance and greater patient convenience, findings of this study suggest that sustained-release corticosteroid use during cataract surgery was low and associated with cost increases to the health care system vs conventional postoperative eye drops. As these new products must be priced high enough to qualify for the Medicare pass-through program, unreasonable cost may have been a deterrent to their use, suggesting that the current Medicare reimbursement rules may not be appropriate for sustained-release postoperative corticosteroids in cataract surgery.
与传统的术后皮质类固醇眼药水相比，缓释皮质类固醇具有提高依从性和为白内障手术后抗炎治疗提供更大便利性的潜力。然而，它们的价格要高得多，后者一直是标准治疗。
研究在美国白内障手术期间接受临时通过补偿计划的 Medicare 患者中使用和成本缓释皮质类固醇。
设计、设置和参与者：这项横断面研究检查了 Medicare 按服务付费 (FFS) 索赔，这些索赔来自至少有 12 个月 Medicare 登记的受益人，他们在 2019 年 3 月至 2021 年 12 月期间至少进行了 1 次白内障手术。排除了年龄小于 65 岁的患者、缺少人口统计信息的患者、每只眼睛接受 1 次以上白内障手术的患者以及在手术当天接受 1 次以上皮质类固醇的患者。识别了同时使用 9%地塞米松眼内悬浮液或地塞米松眼内插入物的白内障手术。提取了手术和药物的外科医生人口统计学特征和成本信息。数据于 2022 年 6 月 15 日至 12 月 4 日进行分析。
白内障手术中使用 9%地塞米松眼内悬浮液或地塞米松眼内插入物。
在接受白内障手术的 Medicare FFS 受益人中，9%地塞米松眼内悬浮液和地塞米松眼内插入物的利用率和成本。
在 Medicare FFS 受益人中进行了总计 4252532 例白内障手术（平均[SD]年龄，74.8[5.8]岁；男性[40.7%]1730811 人，女性[59.3%]2521721 人），由 12284 名眼科医生进行（8876 名男性[72.3%]，2877 名女性[23.4%]，531 名性别不明[4.3%]）。共有 34627 名（0.8%）受益人为接受 9%地塞米松眼内悬浮液，73430 名（1.7%）接受地塞米松眼内插入物；在研究期间，这两种药物的使用均有所增加。9%地塞米松眼内悬浮液和地塞米松眼内插入物的 Medicare 允许收费平均值（SD）分别为 531.47（141.52）美元和 538.49（63.79）美元。
尽管提供了提高依从性和为白内障手术后患者提供更大便利的潜力，但这项研究的结果表明，缓释皮质类固醇的使用较低，与传统的术后眼药水相比，这会增加医疗保健系统的成本。由于这些新产品的定价必须高到足以符合 Medicare 通过计划的资格，因此过高的价格可能是其使用的障碍，这表明当前的 Medicare 报销规则可能不适合白内障手术后的缓释术后皮质类固醇。
