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. 2016 Dec 7:10:2443-2453.
doi: 10.2147/OPTH.S114006. eCollection 2016.

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

Szilárd Kiss  1 , Hitesh S Chandwani  2 , Ashley L Cole  2 , Vaishali D Patel  2 , Orsolya E Lunacsek  3 , Pravin U Dugel  4
Affiliations

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

Szilárd Kiss et al. Clin Ophthalmol. .

Abstract

Purpose: To 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 methods: A 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.

Results: All 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.

Conclusion: This 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.

Keywords: diabetes; health care resource utilization; pseudophakic; real-world evidence; retinal disease.

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Conflict of interest statement

SK reports consulting fees or honoraria, Alimera Sciences Inc., Allergan, Alcon, EyeTech, Genentech, Merge/OIS, Optos, Regeneron, and ThromboGenics; speakers bureaus, Alimera, Allergan, Genentech, Optos, Regeneron, and ThromboGenics; clinical research projects, Allergan, Genentech, Optos, and Regeneron; stock/stock options, Merge/OIS. HSC and VDP are employees of Allergan, and ALC was an employee of Allergan at the time of analysis. OEL is an employee of Xcenda. PUD is a consultant for and receives research grants from Allergan. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Study timeline.
Figure 2
Figure 2
Prevalence of diabetes-related comorbidities (top) and ocular comorbidities (bottom) during follow-up among DME cases and non-DME controls. Notes: *P<0.05, **P<0.001. Abbreviations: AMD, age-related macular degeneration; BRVO, branch retinal vein occlusion; CRVO, central retinal vein occlusion; DME, diabetic macular edema; DR, diabetic retinopathy; RVO, retinal vein occlusion.
Figure 3
Figure 3
Prevalence of diabetes-related comorbidities (top) and ocular comorbidities (bottom) during follow-up among pseudophakic DME cases and non-DME controls. Notes: *P<0.05, **P<0.001. Abbreviations: AMD, age-related macular degeneration; BRVO, branch retinal vein occlusion; CRVO, central retinal vein occlusion; DME, diabetic macular edema; DR, diabetic retinopathy; RVO, retinal vein occlusion.
Figure 4
Figure 4
Resource utilization during follow-up among DME cases and non-DME controls: average number of visits/visit days per utilizing patient. Note: *P<0.001. Abbreviations: DME, diabetic macular edema; ER, emergency room.
Figure 5
Figure 5
Resource utilization during follow-up among pseudophakic DME cases and pseudophakic non-DME controls: average number of visits/visit days per utilizing patient. Note: *P<0.05, **P<0.001. Abbreviations: DME, diabetic macular edema; ER, emergency room.
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