Costs and Quality of Life in Diabetic Macular Edema: Canadian Burden of Diabetic Macular Edema Observational Study (C-REALITY)

Abstract

Purpose. To characterize the economic and quality of life burden of diabetic macular edema (DME) in Canadian patients. Patients and Methods. 145 patients with DME were followed for 6 months with monthly telephone interviews and medical chart reviews at months 0, 3, and 6. Visual acuity in the worst-seeing eye was assessed at months 0 and 6. DME-related healthcare costs were determined over 6 months, and vision-related (National Eye Institute Visual Functioning Questionnaire) and generic (EQ-5D) quality of life was assessed at months 0, 3, and 6. Results. Mean age of patients was 63.7 years: 52% were male and 72% had bilateral DME. At baseline, visual acuity was categorized as normal/mild loss for 63.4% of patients, moderate loss for 10.4%, and severe loss/nearly blind for 26.2%. Mean 6-month DME-related costs/patient were as follows: all patients (n = 135), $2,092; normal/mild loss (n = 88), $1,776; moderate loss (n = 13), $1,845; and severe loss/nearly blind (n = 34), $3,007. Composite scores for vision-related quality of life declined with increasing visual acuity loss; generic quality of life scores were highest for moderate loss and lowest for severe loss/nearly blind. Conclusions. DME-related costs in the Canadian healthcare system are substantial. Costs increased and vision-related quality of life declined with increasing visual acuity severity.

Optical Coherence Tomography Angiography of DME and Its Association with Anti-VEGF Treatment Response

“…2,18 Nevertheless, there are still concerns about the cost-effectiveness of anti-VEGF drugs in chronic or anti-VEGF-resistant cases because multiple injections might place a considerable burden on diabetic patients and the social economy. 4 To avoid ineffective repeated injections, it is important to screen for anti-VEGF-resistant DME in baseline examinations. Although several studies have evaluated the hard exudate or inflammatory status to identify variables predicting the treatment response, 3,19 we focused on the structure of the retinal blood vessel itself because VEGF targets the endothelial cells of blood vessels.…”

“…2 In contrast, in the case of anti-VEGFeresistant DME, which suggests chronic inflammation, corticosteroids are an alternative treatment option. 3 Because the cost of anti-VEGF agents is a major burden for patients with DME, 4 it is necessary to identify factors in baseline examinations that can predict the treatment response to anti-VEGF agents.…”

Same-Day Bilateral Intravitreal Anti-Vascular Endothelial Growth Factor Injections: Experience of a Large Canadian Retina Center

“…Even though less frequent dosing such as treat and extend or as-needed regimens have been proven to be efficient in various clinical trials, many patients frequently still require monthly injections [1, 5, 6]. In addition, patients often show up with bilateral eye involvement, and the rate of bilateral anti-VEGF treatment has been described as 36% for nAMD and 48% for DME [7-9]. Consequently, more frequent visits to the treating retinal specialist are required, increasing the burden on patient’s time and productivity and the administrative load on the health-care system.…”

Comorbidity and health care visit burden in working-age commercially insured patients with diabetic macular edema

“…DME is debilitating because it may lead to progressive vision loss, negatively affecting the patient’s quality of life 4,7. In the US, DM is the primary cause of blindness among adults aged 20–74 8.…”