Comorbidity and health care visit burden in working-age commercially insured patients with diabetic macular edema

Abstract

PurposeTo examine the comorbidity profile and update estimates of health care resource utilization for commercially insured, working-age adults with diabetic macular edema (DME) relative to a matched comparison group of diabetic adults without DME. Additional comparisons were made in the subgroup of pseudophakic patients.Patients and methodsA retrospective matched-cohort study of commercially insured diabetic adults aged 18–63 years was conducted using medical and outpatient pharmacy claims (July 1, 2008–June 30, 2013). Outcomes included diabetes-related and ocular comorbidities and health care resource utilization (any health care visit days, outpatient visit days, inpatient visit days, emergency room visits, eye care-related visit days, unique medications) in the 12-month post-index period.ResultsAll diabetes-related and ocular comorbidities were significantly more prevalent in DME cases versus non-DME controls (P<0.05). A significantly greater proportion of DME cases utilized eye care-related visits compared with non-DME controls (P<0.001). DME cases had almost twice the mean number of total health care visit days compared to non-DME controls (28.6 vs 16.9 days, P<0.001), with a minority of visit days being eye care-related (mean 5.1 vs 1.5 days, P<0.001). Similar trends were observed in pseudophakic cohorts.ConclusionThis working-age DME population experienced a mean of 29 health care visit days per year. Eye care-related visit days were a minority of the overall visit burden (mean 5 days) emphasizing the trade-offs DME patients face between managing DME and their overall diabetic disease. Insights into the complex comorbidity profile and health care needs of diabetic patients with DME will better inform treatment decisions and help optimize disease management.

Real-world outcomes of observation and treatment in diabetic macular edema with very good visual acuity: the OBTAIN study

“…The primary outcome is set as VA loss of ≥ 5 letters after 2 years [ 13 ]. It is vital to know whether early treatment in DME patients with very good visual acuity leads to better long-term visual outcomes, since anti-VEGF treatment is not without ocular and systemic risk [ 17 , 18 ], and cause high costs to healthcare system and patient [ 19 ].…”

Systematic review: non-adherence and non-persistence in intravitreal treatment

“…As patients with DME are younger in average than nAMD patients, conflicts with work or other appointments may present a greater barrier in this population. In addition, the minority of the overall healthcare visits (mean of 29 visit days per year) were due to eye care-related visit days, indicating the complex comorbidity profile and their care in diabetic patients with DME [72].…”

Fluocinolone acetonide (0.19 mg) intravitreal implant reduces treatment burden and improves practice resource utilisation for patients with diabetic macular oedema

“…Reduced injection and clinic visit frequency may improve patient adherence to treatment. This is suggested by the stronger concordance between RCTs and real-world studies of patients receiving the FAc implant compared with RCT and real-world studies of patients receiving anti-VEGF injections for DME 11 18 19. Patients that require frequent injections but are not able to comply with frequent clinic visits may be able to receive adequate treatment with fewer clinic visits after the FAc implant with potentially better oedema control and long term visual outcomes due to better treatment adherence.…”

“…Patients with DME have an even heavier treatment burden. Studies have shown that patients with DME, on average, have one doctor appointment every 2 weeks 11. Furthermore, for every injection visit, greater than 50% of working patients need to take a day off, greater than 70% of patients need care-taker assistance and more than half of patients have anxiety for at least 2 days leading up to ocular injection visits.…”