Abstract
Purpose :
Stargardt disease (SD) is the most common juvenile onset macular degeneration, causing central vision loss in the young. As a progressive and incurable condition it entails a long-term economic burden. The healthcare costs of SD have not been fully quantified, so we aimed to estimate the direct healthcare cost of SD.
Methods :
We analyzed outpatient insurance claims data from the Truven Health MarketScan® Commercial Claims and Encounters Database (2010-2014) for patients with SD. We selected two controls: bilateral sensorineural hearing loss (SHL) as another condition with sensory impairment, and nonexudative age related macular degeneration (AMD) as it causes similar central visual deficits. All patients were aged <65 years. Claims with a primary position diagnosis of SD, SHL or AMD (ICD-9 codes 362.75, 389.18 and 362.51, respectively) were selected. Patients with cochlear implants, exudative AMD, cystoid macular degeneration, macular cyst, hole or pseudohole, macular pucker or toxic maculopathy were excluded. Gross median payments to providers for health services per year of insurance coverage, accounting for periods of non-coverage were calculated. The Wilcoxon rank-sum test was used to test for differences between groups. Multivariable quantile regression was used to adjust for age, sex and residential region.
Results :
A total of 487,292 patients were analyzed (4,928, 369,706 and 112,658 for SD, SHL and AMD respectively). The median (interquartile range, IQR) number of records/year of insurance coverage was 1.20 (0.60-2.33), 0.80 (0.50-1.50) and 1.00 (0.50-2.00) for SD, SHL and AMD respectively. The median (IQR) payments/year of insurance coverage for SD, SHL and AMD were $107.27 (51.83-222.76), $51.01 (25.66-121.64) and $74.61 (37.28-152.07) respectively. Payments for SD were higher than payments for SHL (p<0.0001) and AMD (p<0.0001). Based on the multivariable regression, adjusted payments/year of insurance coverage for SD were $53.81 higher than SHL (p<0.001) and $27.96 higher than AMD (p<0.001).
Conclusions :
SD entails a significant direct healthcare cost for patients. In this limited data set, the annual per-patient cost of SD was higher than SHL, another condition with sensory impairment, and nonexudative AMD which causes a similar pattern of visual loss with a later age of onset. The total lifetime per-patient cost of SD may exceed that of nonexudative AMD.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.