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. 2020 Dec 29;10(12):e042484.
doi: 10.1136/bmjopen-2020-042484.

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

Ha-Lim Jeon  1 , Hyesung Lee  1 , Dongwon Yoon  1 , Yeonkyung Lee  2 , Jae Hui Kim  3 , Donghyun Jee  4 , Ju-Young Shin  5
Affiliations

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

Ha-Lim Jeon et al. BMJ Open. .

Abstract

Objective: To 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.

Design: Retrospective cohort study.

Setting: The Korean National Health Insurance (NHI) database from 1 January 2014 to 31 December 2016.

Participants: We 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 measures: One-year healthcare resource use and direct medical costs of patients with DME treated with anti-VEGF.

Results: In 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.

Conclusions: The 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.

Keywords: diabetic retinopathy; public health; vitreoretinal.

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Conflict of interest statement

Competing interests: J-YS reported receiving grants from the Ministry of Food and Drug Safety, the Ministry of Health and Welfare, the National Research Foundation of Korea, and Government-wide R&D Fund for infectious disease research; and grants from pharmaceutical companies including Amgen, Pfizer, Hoffmann-La Roche, Dong-A ST and Yungjin, outside the submitted work. H-LJ, HL, DY and J-YS reported grants from Bayer, the National Research Foundation of Korea, and Government-wide R&D Fund for infectious disease research. YL is an employee of Bayer Korea. JHK is a consultant for Bayer Korea in this study. DJ has no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Study scheme and selection of patients with DME treated with anti-VEGF (A), DM without retinopathy (B), and nAMD treated with anti-VEGF (C). Anti-VEGF, antivascular endothelial growth factor; DM, diabetes mellitus; DME, diabetic macular oedema; nAMD, neovascular age-related macular degeneration.
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