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Chris John Wallick, Ryan N Hansen, Joanna Campbell, Jonathan W Kowalski, Szilard Kiss, Sean D Sullivan; Increased health care utilization among patients with diabetic macular edema compared with diabetic patients without edema. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1751.
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© ARVO (1962-2015); The Authors (2016-present)
Diabetic macular edema (DME) serves not only as a marker of progression and severity of diabetes but also in itself adds to the increasing burden of medical care in diabetic patients. However, the specific effect of having DME on health care utilization among patients with diabetes remains unclear. The objective of the present study was to examine health care utilization in a working-age commercially insured cohort of patients with diabetes and to compare resource utilization in diabetic patients with and without DME.
A retrospective cohort study was carried out using enrollment and health care claims data from the Truven Marketscan Commercial Claims and Encounters Database, a large database of insured, working age adults in the US. We matched an incident (2008-2011) DME patient group (n=24,326) 1:5 with a non-DME diabetic patient cohort (n=122,710) on age, sex, region, and calendar years with insurance coverage. Claims for relevant procedures and visits to health care specialists were analyzed over 1- and 3- year cohort periods.
Health care resource utilization rates were significantly higher in DME patients than diabetic control patients for every category, including emergency, outpatient, inpatient and eye-care related visits (see table). The mean total number of outpatient visits in 1-year was more than 10 days greater in DME cohort patients than in non-DME patients (25.5 vs. 14.9 days). Among the DME cohort this represents, on average, a visit to a healthcare provider more than once every 2 weeks over the course of a year.
Health care utilization among diabetic patients with macular edema was substantially greater when compared with those patients without DME. This increased burden of medical care was significant across all ophthalmic and non-ophthalmic resource utilization measures. Since the standard-of-care for the treatment of DME during the inclusion period of this study was laser photocoagulation, the more recent emergence of repeated intravitreal injections as a primary treatment modality for DME may likely add to the already high health care utilization for these patients. Given this considerable medical burden for patients with DME (25 visits per year) it is important to consider intravitreal injection frequency when making treatment decisions for this population.
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