April 2011
Volume 52, Issue 14
ARVO Annual Meeting Abstract  |   April 2011
The Economic Burden of Diabetic Macular Edema from a U.S. Private Payer Perspective
Author Affiliations & Notes
  • Paolo Lanzetta
    Dept of Ophthalmology, University of Udine, Udine, Italy
  • Karen Van Nuys
    Precision Health Economics, Santa Monica, California
  • Irwin Tran
    Genentech Inc, South San Francisco, California
  • Meghan Gallagher
    Novartis Pharma AG, Basel, Switzerland
  • Shoshana Colman
    Health Economics & Outcomes Res, Genentech, Inc, South San Francisco, California
  • Darius Lakdawalla
    Shaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California
  • Footnotes
    Commercial Relationships  Paolo Lanzetta, Allergan (R), Neovista Inc (C), Novartis Pharma AG (C, R), QLT Inc (R); Karen Van Nuys, Genentech Inc (C), Novartis Pharma AG (C); Irwin Tran, Genentech Inc (E); Meghan Gallagher, Novartis Pharma AG (E); Shoshana Colman, Genentech Inc (E); Darius Lakdawalla, Genentech Inc (C), Novartis Pharma AG (C)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science April 2011, Vol.52, 5532. doi:
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      Paolo Lanzetta, Karen Van Nuys, Irwin Tran, Meghan Gallagher, Shoshana Colman, Darius Lakdawalla; The Economic Burden of Diabetic Macular Edema from a U.S. Private Payer Perspective. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5532.

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      © ARVO (1962-2015); The Authors (2016-present)

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To assess the direct medical expenditures associated with Diabetic Macular Edema (DME) and Diabetic Macular Edema with Visual Impairment (DME/VI) from a U.S. private payer perspective, compared with diabetes (DM)-only controls.


A large U.S. administrative claims database from private health insurers was used to calculate annual medical expenditures for DME and DME/VI patients compared to DM-only patients from 2002 to 2007. Patients were identified by ICD-9 codes using algorithms from the literature. Descriptive and multivariate analyses were used to determine total annual medical expenditures by group.


The database includes over 450,000 individuals and 1.3 million person-years of data. The population studied was 53% male, with mean age of 63 years; 16.5% had type I DM and 83.5% had type II or unspecified DM. From 2002 to 2007, DM-only controls averaged between $11,915 and $17,387 in annual direct medical expenditures while patients with DME incurred between $20,166 and $29,959 in annual inpatient, outpatient, and pharmaceutical costs. Patients with DME/VI incurred even higher annual costs, ranging between $27,574 and $42,692. Extrapolated to the prevalence of DME in the U.S., the 2007 direct cost burden of illness of DME in the U.S. is estimated to be $5.35 billion.


DME patients incurred consistently higher medical costs than DM-only controls. Patients with DME/VI incurred even higher costs, quantifying for the first time the added burden of VI in DME patients. These findings underscore the financial significance of DME and its associated visual impairment to the patient and society.  

Keywords: diabetic retinopathy • edema 

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