Sustained-Release Corticosteroids Seldom Used in Medicare Cataract Surgeries

Sustained-release corticosteroids use after cataract surgery have been low, and costs high among patients with Medicare in the treatments’ initial years of availability in the US, according to research published in JAMA Ophthalmology. Current pass-through reimbursement rules might not be compatible with these drugs.

Sustained-release corticosteroids present an alternative to topical corticosteroids for inflammation after cataract surgery that are more expensive than corticosteroid eye drops but could be less burdensome for patients. The researchers assessed the cost to patients and the health care system for the drugs’ use in the Medicare pass-through program.

The researchers analyzed Medicare fee-for-service claims for 4,252,532 cataract surgeries that occurred between March 2019 and December 2021.

They found that of the beneficiaries (mean age 74.8 years 59.3% women), 0.8% received dexamethasone intraocular suspension 9% and 1.7% received dexamethasone ophthalmic inserts at surgery.

Surgeons increased use of sustained-release corticosteroids in cataract cases over time. Of the 125,022 December 2021 cataract surgeries, suspension was used in 1.7% of surgeries while the insert was used in 4.1% of surgeries. About 8% of surgeons used sustained-release corticosteroids. Surgeons who used sustained-release corticosteroids had more than double the mean number of annual cataract surgery volume compared with surgeons who did not. Surgeons who did use the suspension included it in their care for a median 11.5 surgeries, or a median 2.7% of the time. Those numbers were more than doubled for inserts. Surgeons who used both these corticosteroids included them in a median 23.5% of their surgeries.

The Medicare-allowed charge for the corticosteroids was $57.9 million. Of that amount, $39.5 million was spent on 73,430 dexamethasone ophthalmic inserts. The rest was for suspensions. The mean allowed charge for the drugs was $531.47 for the suspension and $538.49 for the insert. Surgeon charges overall totaled $2.4 billion. The mean charge per surgery was $568.52.

In 2016, eye drops’ mean cost was $139.80. The health care system would incur $30 million to $120 million more in costs across the 1.5 million annual cataract surgeries if the rate of sustained-release corticosteroids increased to 5% to 20%.

“We believe it would be more reasonable to treat sustained-release drug products administered at the end of surgery for postoperative indications similar to their eyedrop counterparts for reimbursement purposes,” the study authors explain.

Study limitations include reliance on coding accuracy and the influence of COVID-19 pandemic on adoption of new technology.

Disclosure: One or more study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.