Direct medical cost associated with diabetic retinopathy severity in type 2 diabetes in Singapore

Abstract

Diabetic retinopathy (DR) is a leading cause of vision-loss globally among type 2 diabetes (T2DM) patients. Information on the economic burden of DR in Singapore is limited. We aim to identify the total annual direct medical costs of DR at different stages, and to examine factors influencing the costs. Four hundreds and seventy T2DM patients who attended the Diabetes Centre in a secondary hospital in Singapore in 2011–2014 were included. Digital color fundus photographs were assessed for DR in a masked fashion. Retinopathy severity was further categorized into non-proliferative DR (NPDR), including mild, moderate and severe NPDR, and proliferative DR (PDR). Medical costs were assessed using hospital administrative data. DR was diagnosed in 172 (39.5%) patients, including 51 mild, 62 moderate and 18 severe NPDR, and 41 PDR. The median cost in DR [2012.0 (1111.2–4192.3)] was significantly higher than that in non-DR patients [1158.1 (724.1–1838.9)] (p<0.001). The corresponding costs for mild, moderate, severe NPDR and PDR were [1167.1 (895.4–2012.0)], [2212.0 (1215.5–3825.5)], [2717.5 (1444.0–6310.7)], and [3594.8.1 (1978.4–8427.7)], respectively. After adjustment, the corresponding cost ratios for mild, moderate, severe NPDR, and PDR relative to non-DR were 1.1 (p = 0.827), 1.8 (p = 0.003), 2.0 (p = 0.031) and 2.3 (p<0.001), respectively. The other factors affecting the total cost include smoking (ratio = 1.7, p = 0.019), neuropathy (ratio = 1.9, p = 0.001) and chronic kidney disease (CKD) (ratio = 1.4, p = 0.019). The presence and severity of DR was associated with increased direct medical costs in T2DM. Our results suggest that preventing progression of DR may reduce the economic burden of DR.

Neurodegeneration in diabetic retinopathy: does it really matter?

“…For these reasons individuals with diabetic retinopathy represent a significant cost for healthcare systems, only part of which is due to ophthalmic care [15–17]. Therefore, strategies to prevent or delay the progression of diabetic retinopathy would lead to a decrease in its associated economic burden [17].…”

“…Therefore, strategies to prevent or delay the progression of diabetic retinopathy would lead to a decrease in its associated economic burden [17]. In addition, improved awareness of diabetic retinopathy and its assessment in at-risk individuals will make possible the earlier detection of other systemic complications of diabetes.…”

“…For these reasons individuals with diabetic retinopathy represent a significant cost for healthcare systems, only part of which is due to ophthalmic care [ 15 – 17 ]. Therefore, strategies to prevent or delay the progression of diabetic retinopathy would lead to a decrease in its associated economic burden [ 17 ]. In addition, improved awareness of diabetic retinopathy and its assessment in at-risk individuals will make possible the earlier detection of other systemic complications of diabetes.…”

Review of the Effectiveness of Information and Communication Technology (ICTs) in the Treatment of Type 1 and Type 2 Diabetes

“…In the Zhangx et al study, they were able to absorb enough patients in the first year after the diagnosis, thus extending the criteria for inclusion to include diabetes patients who had been referred for more than a year before enrollment Thus, the study found a new number of diabetic patients and most participants were exposed to diabetic drugs or just a drug and yet found no relationship between the duration of illness and the duration of membership in diabetes mobile study studies. However, overall positive results have been reported [23].…”

Implementation and sustainment of a statewide telemedicine diabetic retinopathy screening network for federally designated safety-net clinics

“…Yet DR screening rates in the US remain low [ 9 , 10 ], especially among vulnerable populations [ 11 – 14 ]. These missed opportunities for secondary prevention decrease productivity [ 15 ], increase morbidity [ 16 , 17 ], and increase healthcare expenditures [ 18 , 19 ]. With effective treatments for DR available, the more intractable challenge has been consistent screening for early identification of those requiring closer monitoring or therapeutic intervention.…”