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Hitesh Chandwani, Szilard Kiss, Ashley Cole, Vaishali D Patel, Orsolya Lunacsek, Pravin U Dugel; Comorbidity and healthcare visit burden in working-age commercially insured diabetic macular edema patients. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2146. doi: https://doi.org/.
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Treatment and follow-up of 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 not been studied extensively. The purpose of this study was to assess the comorbidity burden and healthcare resource utilization among working-age diabetics with DME compared to those without DME.
A retrospective matched cohort study of DME patients vs diabetics without DME was conducted using the MarketScan® Commercial Claims and Encounters Database. Eligible adult (18-63 years of age) cases were required to have the first (index) DME (ICD-9-CM code 362.07) claim between 01/01/2011 and 06/30/2012, with continuous enrollment in the pre-index (30 months) as well as post-index (12 months) periods. The controls included diabetic patients without DME. Cases and controls were matched 1:3 on age at index date (±2 years), gender, region, and index year. Rates of diabetes-related comorbidities and mean annual healthcare visits per utilizing patient in the 12 months post-index were compared between cohorts.
There were 4,006 eligible DME cases with a matched control cohort of 12,018 non-DME diabetics. The proportion of cases with diabetes related comorbidities (myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, stroke, renal disease, lower limb amputation) in the post-index period was significantly higher than the proportion of controls (p<0.001 for all). Compared to the control group, on average, the DME cohort had significantly higher total healthcare visit days (28.6 vs. 16.9, p<0.001) [Fig. 1], primarily driven by differences in outpatient visits (27.0 vs. 16.1, p<0.001). Eye-care related visits were also significantly higher in the DME cases, but were a small proportion of overall healthcare utilization (5.1 vs. 1.5, p<0.001) [Fig 1].
Our analysis reveals a significant comorbidity and healthcare utilization burden for the working-age DME population compared to diabetes without macular edema. The burden of ~30 healthcare visits in a year is especially challenging in this working-age population, and might present a choice between seeking treatment and going to work.
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