Healthcare costs associated with progressive diabetic retinopathy among National Health Insurance enrollees in Taiwan, 2000-2004

Abstract

BackgroundDiabetic retinopathy is one of the most common microvascular complications of diabetes and one of the major causes of adult visual impairment in national surveys in Taiwan. This study aimed to identify the healthcare costs of Taiwan's National Health Insurance program on behalf of diabetic patients with stable or progressive retinopathy.MethodsA retrospective cohort study was conducted with 4,988 medication-using diabetic retinopathy subjects ≥ 40 years of age under National Health Insurance Program coverage between 2000 and 2004. Study cohort subjects were recorded as having diabetic retinopathy according to ICD-9-CM codes. States of diabetic retinopathy were strategically divided into stable and progressive categories according to subjects' conditions at follow-up in 2004. Expenditures were calculated and compared for the years 2000 and 2004.ResultsDuring the 4-year follow-up (2000 through 2004), 4,116 subjects (82.5%) of 4,988 diabetic subjects were in the stable category, and 872 (17.5%) were in the progressive category. Average costs of those in the normal category increased by US $48 from US $1921 in 2000 to US $1969 in 2004 (p = 0.594), whereas costs for those progressing from normal to non-proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR) increased by US $1760, from US $1566 in 2000 to US $3326 in 2004 (p < 0.001). The PDR category had the highest average costs at US $3632 in 2000. The NPDR-to-PDR category experienced the greatest increase in costs at US $3482, from US $2723 in 2000 to US $6204 in 2004 (p = 0.042), and the greatest percentage of increase at 2.3% (2.2% when adjusted by comparing to normal category).ConclusionsThis large-scale longitudinal study provides evidence that increased healthcare costs are associated with progressive diabetic retinopathy among diabetic NHI enrollees in Taiwan.

Changes in prevalence of diabetic complications and associated healthcare costs during a 10-year follow-up period among a nationwide diabetic cohort

“…Most existing studies have adopted the cross-section study design and reported only point estimates of annual prevalence of diabetic complications and associated costs (Chang, Weiner, Richards, Bleich, & Segal, 2012a;Rosenzweig, Weinger, Poirier-Solomon, & Rushton, 2002;Ward, Alvarez, Vo, & Martin, 2014). Furthermore, some of them were limited to specific diabetic complications (such as cardiovascular complications (Straka, Liu, Girase, DeLorenzo, & Chapman, 2009) and retinopathy (Woung, Tsai, Chou, et al, 2010)) and related medical costs. For example, Woung et al (2010) reported significant increase of costs associated with diabetic retinopathy (US $1566in 2000to US $3326 in 2004).…”

“…For example, Woung et al (2010) reported significant increase of costs associated with diabetic retinopathy (US $1566in 2000to US $3326 in 2004). Some studies also were limited to incremental costs between diabetic cohort and their non-diabetic counterparts only (Brown, Pedula, & Bakst, 1999;Farshchi, Esteghamati, Sari, et al, 2014;Straka et al, 2009;Woung et al, 2010).…”

“…Furthermore, most longitudinal studies only included diabetic patients free of complications but not diabetic patients with different severity of complications at cohort entry (Farshchi et al, 2014;Woung et al, 2010). In addition, some of the existing studies were limited to data derived from simulation models (Zhuo, Zhang, & Hoerger, 2013) instead of "real-world" data (Brandle et al, 2003;Caro, Ward, & O'Brien, 2002).…”

“…Furthermore, some of them were limited to specific diabetic complications (such as cardiovascular complications (Straka, Liu, Girase, DeLorenzo, & Chapman, 2009) and retinopathy (Woung, Tsai, Chou, et al, 2010)) and related medical costs. For example, Woung et al (2010) reported significant increase of costs associated with diabetic retinopathy (US $1566in 2000to US $3326 in 2004). Some studies also were limited to incremental costs between diabetic cohort and their non-diabetic counterparts only (Brown, Pedula, & Bakst, 1999;Farshchi, Esteghamati, Sari, et al, 2014;Straka et al, 2009;Woung et al, 2010).…”

Predicting Development of Proliferative Diabetic Retinopathy

“…One study found the average cost of caring for patients with NPDR to be 292 USD, while it cost 1,207 USD to manage patients who develop PDR (6). Another study conducted by the National Health Services in Taiwan found that individuals who progressed from NPDR to PDR were noted to have an increase in expenditures of 3,482 USD (7). The ability for clinicians to identify and treat patients early in the disease process, before they experience progression to PDR, may result in considerable cost savings, especially in light of the growing number of individuals with diabetes mellitus (DM) in the U.S. population.…”