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L. Curtis, A. Shea, B. Hammill, J. Kowalski, A. Ravelo, P. Lee, K. Schulman; Resource Utilization and Direct Medical Costs to Medicare for Beneficiaries With Incident Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3757.
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To examine trends in resource utilization and the impact of incident diabetic macular edema (DME) on 1- and 3-year total direct medical costs in elderly patients with diabetes.
We used a nationally representative 5% sample of Medicare beneficiaries from 2000-2004 to identify incident DME patients, and a diabetic control cohort with no history of retinal disease. We summed Medicare reimbursement amounts for all inpatient, outpatient, home health, skilled nursing, hospice, durable medical equipment, and professional service claims and applied generalized linear models to estimate the effect of DME on 1- and 3-year costs. We also examined 1-year resource utilization.
Both one- and three-year mean total direct medical costs were approximately 25% higher among DME cases than diabetic controls. In univariate analyses, DME was associated with 34% higher 1-year costs and 33% higher 3-year costs. Controlling for age, sex, race, geographic region, and baseline comorbid diagnoses, DME was still a significant independent predictor of total medical costs at 1 and 3 years. In multivariable analyses, DME was associated with 25% higher 1-year costs and 27% higher 3-year costs. Significant shifts in the use of DME treatment modalities were observed over time. From 2000 to 2004, treatment of incident DME with intravitreal injection increased from 1% to 13% of patients; treatment with OCT increased from 2.5% to more than 40%. The use of laser photocoagulation decreased over time.
After controlling for demographic variables and baseline comorbidities, new onset macular edema was a significant independent predictor of total medical costs at both 1 and 3 years. Diagnostic and treatment modalities used for DME have changed significantly over time.
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