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Deepthi M Reddy, Richard M Feist, Richard M. Feist, John O Mason, michael A. Albert, Martin L Thomley, Claudia Ayala; Effect of Initial Visual Acuity on Cost of Diabetic Macular Edema Treatment. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2144.
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To evaluate the effect of visual acuity on the overall cost of diabetic macular edema treatment before and during the era of anti-vascular endothelial growth factor (anti-VEGF) therapy.
A retrospective study was performed of two groups with clinically significant diabetic macular edema, who began treatment 10 years and 3 years ago, before and after the introduction of anti-VEGF therapy. Patients were stratified into subgroups with entry visual acuity better than 20/40 or 20/40 or worse. Treatment cost for each group and subgroup was calculated using current fee schedules for Medicare and the predominant private insurance carrier for the state of treatment (Alabama).
The 10 year group received solely laser photocoagulation treatment while the 3 year group received both anti-VEGF and laser photocoagulation. Overall, the 3 year group had better visual retention during 2 years of follow up (mean logMAR of visual loss 0.03 versus 0.22, p=0.0029) at 2 years follow up) and a higher mean treatment cost. In the subgroup with 20/40 or worse vision, overall treatment costs ranged from 40% to 45% higher in the 3 year group and only 3% higher in the 10 year group.
Anti-VEGF treatment offers better visual prognosis in clinically significant diabetic macular edema but with a higher cost of treatment. Worse initial visual acuity may incur a higher cost of treatment.
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