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Matt Hill, Ibrahim Abbass, Vincent Garmo, Daniel Sheinson, Avanti Ghanekar, Andrew Moshfeghi; Barriers to treatment in patients newly diagnosed with proliferative diabetic retinopathy. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5320.
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AAO preferred practice patterns recommend treatment in patients (pts) diagnosed with high-risk proliferative diabetic retinopathy (PDR), and sometimes in non-high-risk pts. In a real-world observational analysis, only 1 in 3 pts newly-diagnosed with PDR received treatment within a year following diagnosis. We investigated this study cohort to determine predictors of PDR treatment.
A retrospective cohort study was designed using MarketScan commercial and Medicare claims data. Adult pts newly diagnosed with PDR between 7/1/2008-6/30/2015 were included (verified by 18-month look-back period). Treatment included laser, intravitreal corticosteroids or anti-vascular endothelial growth factor, or surgery within 1 year of diagnosis. Pts with other retinal conditions or related treatments prior to diagnosis were excluded. Logistic regression was utilized to determine the impact of patient and health-system characteristics on likelihood of treatment during follow-up.
5,384 pts met the inclusion criteria. 54% were male and mean age was 57 years. Age was inversely related to treatment likelihood, with pts >75 years being less likely to receive treatment compared to those <50 years (OR=0.32; 95% CI=0.25-0.41). Pts enrolled in PPO plans were more likely to receive treatment than pts enrolled in HMOs (OR=1.34; 95% CI=1.13-1.60). Compared to pts residing in the Northeast, pts in the North Central (OR=1.25, 95% CI=1.04-1.51) and South (OR=1.34, 95% CI=1.13-1.58) were more likely to receive treatment. Baseline use of insulin was associated with lower likelihood of receiving treatment compared to monotherapy (OR=0.77;95% CI=0.62-0.96). Pts with renal failure (OR=0.67; 95% CI=0.56-0.80) and hypothyroidism (OR=0.68;95% CI=0.55-0.83) were less likely to be treated, while pts with congestive heart failure (OR=1.50; 95% CI=1.13-1.98), electrolyte disturbances (OR=1.36; 95% CI=1.12-1.66), hypertension (OR=1.19; 95% CI=1.05-1.34), and severe cardiovascular disease (OR=1.29; 95% CI=1.05-1.58) were more likely to be treated.
The causes of undertreatment in pts with PDR are multifactorial, but older patients, those with debilitating comorbidities such as renal failure, and those in HMO plans represented the populations at highest risk of undertreatment in our analysis. This population should be closely followed and targeted for treatment in order to reduce risk of sight loss.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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