Evolving Visual Results and Cost in Diabetic Macular Edema Treatment

Abstract

Purpose: To evaluate the effect on clinical practice of the introduction of anti-vascular endothelial growth factor (anti-VEGF) treatment for diabetic macular edema.

Methods: Two cohorts with clinically significant diabetic macular edema were identified and studied retrospectively. One group began treatment 10 years prior to identification while the other began treatment 3 years prior to identification. Entry vision, final vision, and treatments were tabulated for each group. Treatment cost was calculated using current fee schedules for Medicare and the predominant private insurance carrier for the state of treatment (Alabama). A maximal and minimal cost model was built for both payer type and by anti-VEGF drug.

Results: Treatment in the 10-year-old cohort consisted entirely of laser photocoagulation while treatment in the 3-year-old cohort consisted of a combination of laser photocoagulation and anti-VEGF treatment. The 3 year cohort had fewer laser procedures (1.8 versus 2.4), better visual retention during 2 years of follow up (mean logMAR of visual loss 0.05 p=.32 versus 0.22 p<.0001 at 2 years follow up) and a higher mean treatment cost. Modeled treatment costs ranged from 7% to over 200% higher in the 3 year cohort. Pricing of the anti-VEGF medication was by far the strongest factor in cost differences among various treatment models.

Conclusions: Pharmacotherapy with anti-VEGF agents offers better visual prognosis for patients with clinically significant diabetic macular edema. This improved prognosis may come with a higher cost of treatment with drug costs composing most of the increase.

Keywords: 499 diabetic retinopathy • 460 clinical (human) or epidemiologic studies: health care delivery/economics/manpower • 688 retina