Abstract
Purpose: :
To characterize the economic and societal burden of Diabetic Macular Edema (DME) in Canada.
Methods: :
Patients with clinically significant macular edema (CSME) were enrolled by ophthalmologists and retinal specialists across Canada. Patients were followed over a 6-month period to combine prospective data collected during monthly telephone interviews and at sites at months 0, 3 and 6. Visual acuity (VA) was measured and DME-related health care resource information was collected. Patient health-related quality of life (HRQOL) was measured using the National Eye Institute Visual Functioning Questionnaire (VFQ-25), and the EuroQol Five Dimensions (EQ-5D).
Results: :
A total of 145 patients [mean age 63.7 years (range: 30-86 yrs); 52% male; 81% Type 2 diabetes; mean duration of diabetes 18 years (range: 1-62 yrs); 72% bilateral CSME] were enrolled from 16 sites across 6 provinces in Canada. At baseline, the mean VA was 20/60 (range: 20/20-20/800) across all eyes diagnosed with CSME (249 eyes). Sixty-eight percent of patients had VA severity in the worse seeing eye of normal/mild vision loss (VA 20/10 to ≥ 20/80), 19% moderate vision loss (VA < 20/80 to ≥ 20/200), and 13% severe vision loss/nearly blind (VA < 20/200). Over the 6-month period, 11% of patients received one or more steroid injection, 29% received one or more anti-VEGF injection, 57% received laser photocoagulation, and 6% received vitrectomy. At month 6, the mean VFQ-25 composite score was 79.6 (scores range from 0 to 100 with higher scores represent better functioning), the mean EQ-5D utility score was 0.78 (0 represents death and 1 represents perfect health), and the EQ visual analogue scale (VAS) score was 71.0 (0 represents the worst imaginable health state and 100 represents the best). The average 6-month DME-related cost per patient was $2,092 across all patients (95% confidence interval: $1,694 to $2,490). The cost was $1,820 for patients with normal/mild vision loss, $2,911 for patients with moderate vision loss, and $2,304 for patients with severe vision loss/nearly blind.
Conclusions: :
DME is associated with limitations in functional ability and quality of life. In addition, the DME-related cost is substantial to the Canadian health care system.
Keywords: clinical (human) or epidemiologic studies: health care delivery/economics/manpower • diabetes • macula/fovea