Burden of diabetic macular oedema in patients receiving antivascular endothelial growth factor therapy in South Korea: a healthcare resource use and cost analysis

Abstract

ObjectiveTo examine healthcare resource utilisation (HRU) and direct medical costs for patients with diabetic macular oedema (DME) treated with antivascular endothelial growth factor (anti-VEGF) in Korea by comparing with those for (1) patients with diabetes mellitus (DM) without retinopathy and (2) patients with neovascular age-related macular degeneration (nAMD) treated with anti-VEGF.DesignRetrospective cohort study.SettingThe Korean National Health Insurance (NHI) database from 1 January 2014 to 31 December 2016.ParticipantsWe identified 1398 patients older than 30 years of age who received anti-VEGF treatment for DME in 2015 after excluding patients who had a diagnosis of nAMD in 2015 and any cancer in the preceding year.Main outcome measuresOne-year healthcare resource use and direct medical costs of patients with DME treated with anti-VEGF.ResultsIn total, 1398 patients with DME receiving anti-VEGF, 12 813 patients with DM without retinopathy and 12 222 patients with nAMD receiving anti-VEGF were identified. Hospital admissions and outpatient visits were highest in patients with DME, while the number of licensed anti-VEGF injections in those with DME was about half that of those with nAMD (2.1 vs 3.9 per patient per year). Mean 1-year medical costs were also higher in patients with DME (US$6723) than in those with DM without retinopathy (US$2687) and nAMD (US$4980). In a multivariable analysis with matched cohorts, DME was associated with 66% higher medical costs for comorbid diseases (adjusted OR (aOR), 1.66; 95% CI 1.45 to 1.90) and 50% lower anti-VEGF injections (aOR, 0.50; 95% CI 0.46 to 0.54) compared with nAMD.ConclusionsThe overall HRU and economic burden for DME treated with anti-VEGF were higher than for DM without retinopathy or for nAMD treated with anti-VEGF. Meanwhile, the lower number of licensed anti-VEGF injections compared with nAMD may reflect a potential lack of ophthalmological treatment for DME supported by the NHI in Korea.

Nocturnal normobaric hyperoxia treatment in a case of chronic diabetic macular edema

“…One of the main benefits of NNBH is that it provides a less invasive and less expensive method for treating DME and vision loss compared to intravitreal injections, which are associated with high costs and burdens for patients. 8 The transition from twelve to zero intravitreal injections over a one-year span demonstrates a drastic reduction in treatment burden in this case.…”

Mechanisms of macular edema

“…Around one-third of patients with uveitis develop macular edema, being more frequent in intermediate uveitis and panuveitis, and less common in anterior uveitis (14,15). The burden of macular edema not only relates to the decrease in quality of life experienced by patients, but also to the chronicity of the condition and the economic costs associated with treatment and frequent visits to medical centers (18)(19)(20). In uveitic macular edema in particular, the most affected population group is of working age, adding to the socioeconomic impact of the condition (21-23).…”

Rho-Kinase Inhibitors for the Treatment of Refractory Diabetic Macular Oedema

“…Considering these facts and the administration protocols, DMO accounts for not only a substantial percentage of patients at ophthalmological retinal consultations but enormous care and economic load for any healthcare system, unaffordable for a single person [ 96 ]. It is an issue of grave concern, and its application in a sustainable manner, selecting the appropriate drugs and dosage, is quite popular nowadays [ 93 , 94 , 96 , 97 , 98 , 99 ]. Therefore, new treatment modalities exploring new pathways that could overcome the shortcomings of current therapies are required.…”