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Joanna Campbell, Pravin U Dugel, Ashley Cole, Orsolya Lunacsek, Amanda Forys, Herman Chen, Hitesh Chandwani, Szilard Kiss; Comorbidity and Healthcare Visit Burden in Elderly Diabetic Macular Edema Patients. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2145. doi: https://doi.org/.
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Treatment for diabetic macular edema (DME) is only one component of the total healthcare burden faced by DME patients, who typically have longstanding diabetic disease. The total healthcare burden of DME patients has recently become a topic of interest. This study assesses comorbidity rates and healthcare use in elderly diabetics with DME compared to those without DME.
A retrospective matched cohort study of DME patients vs diabetics without DME was conducted using the Centers for Medicare and Medicaid Services 5% Standard Analytic Files. DME cases (≥68 years of age) with their first (index) diagnosis of DME (ICD-9-CM 362.07), and non-DME controls with a diagnosis of diabetes (ICD-9-CM 250.xx) and no DME, were identified between 07/01/2010 and 12/31/2011. Both cohorts required continuous enrollment for 30 months pre-index and 12 months post-index. Cases and controls were matched 1:3 on age at index (±2 years), gender, region, and index year. Rates of diabetes-related comorbidities and mean annual healthcare visits per utilizing patient 12 months post-index were compared between cohorts with chi-square tests and Wilcoxon rank sum tests, respectively.
There were 889 DME cases matched to 2,667 non-DME controls. The proportion of cases with all diabetes-related comorbidities assessed (myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, stroke, renal disease, lower limb amputation) was significantly higher than for controls (p< 0.05 for all). Compared to controls, DME patients had significantly higher total healthcare visit days (46.5 vs 34.5, p<0.001), primarily driven by differences in outpatient visits (31.2 vs 23.5, p<0.001) [Fig. 1]. Eyecare-related visits were also significantly higher in the DME cases, but were a small proportion of overall healthcare utilization (4.5 vs 1.7, p<0.001) [Fig 1].
DME patients have a significant health care burden over diabetics without DME; therefore, intensive treatments that could increase utilization with health care professionals may not be feasible. Treatments that require less frequent dosing may benefit this population.
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