THE ECONOMIC BURDEN OF DIABETIC MACULAR EDEMA IN A WORKING AGE AND COMMERCIALLY INSURED POPULATION

Thesis (Master's)--University of Washington, 2013INTRODUCTION: Diabetic Macular Edema (DME) is the leading cause of blindness amongst working age adults in most developed countries. Diagnosis and treatment of DME involves many visits to specialists, numerous medications, and great cost. The primary objective of this study was to describe the economic burden of DME in a commercially insured working age population. METHODS: We conducted a retrospective cohort study using enrollment and health care claims information from a large database of commercially insured, working age adults. We matched a cohort of patients with a claim for DME 1:5 to a diabetic control group without DME and reported health care utilization and cost over a 1, 2 and 3 year period. RESULTS: The DME cohort had significantly more comorbidities and a higher Charlson Comorbidity Index (CCI) scores than the matched diabetic control cohort. Health care resource utilization rates were significantly higher in DME patients than diabetic control patients for every category. DME patients had claims for significantly higher counts of emergency, outpatient, and inpatient visits than the diabetic control cohort. The total number of days with a visit to any healthcare provider was on average more than 10 days greater in DME cohort patients than in non-DME diabetic patients (27.01 vs. 16.13 days). Among the DME cohort this represents, on average, a visit to a healthcare provider more than once every 2 weeks over the course of a year. CONCLUSION: We characterized utilization patterns for DME patients and compared them to matched non-DME diabetic patients. We found that DME patients utilized significantly more health care resources and accrued higher costs than the non-DME diabetic patients. DME patients also made more visits to health care professionals. The burden of disease for DME patients is large and may represent a challenge for patients that are trying to attend to family or work. The large and rising cost of treatment only adds burden to patients that are likely already missing work time to visit specialists. DME patients that have nearly 30 days per year with at least one provider visit are likely to have difficult decisions between seeking treatment and taking care of their family or going to work