Effect of Initial Visual Acuity on Cost of Diabetic Macular Edema Treatment

Abstract

Purpose: 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.

Methods: 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).

Results: 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.

Conclusions: 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.