Treatment costs of cystoid macular edema among patients following cataract surgery

Abstract

PurposeThe current costs of treating cystoid macular edema (CME), a complication that can follow cataract surgery, are largely unknown. This analysis estimates the treatment costs for CME based on the recently released US Medicare data.SettingNationally representative database.DesignRetrospective analysis of the 2011 through 2013 Medicare 5% Beneficiary Encrypted Files.MethodsBeneficiaries who underwent cataract surgery were identified and stratified by diagnosis of CME (cases) or no diagnosis of CME (controls) within 6 months following surgery. Claims and reimbursements for ophthalmic care were identified. Subgroup analyses explored the rates of CME in beneficiaries based on the presence of selected comorbidities and by the type of procedure (standard vs complex). Total Medicare and ophthalmic costs for cases and controls are presented. The analysis explored the effect of considering diabetic macular edema (DME) and macular edema (ME) as exclusion criteria.ResultsOf 78,949 beneficiaries with cataract surgery, 2.54% (n=2,003) were diagnosed with CME. One-third of beneficiaries had one or more conditions affecting retinal health (including diabetes), 4.5% of whom developed CME. The rate of CME, at 22.5%, was much higher for those patients with preoperative DME or ME. Ophthalmic charges were almost twice as high for cases compared with controls (US$10,410 vs $5,950); payments averaged 85% higher ($2,720 vs $1,470) (both P<0.0001).ConclusionSubstantial costs can be associated with CME; beneficiaries whose retinas are already compromised before cataract surgery face higher risk. Cost savings could be realized with the use of therapies that reduce the risk of developing CME. Future analyses could identify whether and to what extent comorbidities influence costs.

Quantifying the real-world cost saving from using surgical adjuncts to prevent complications during cataract surgery

“…Schmier et al used United States Medicare Limited Data Sets to identify patients who had developed a specific complication (postoperative CMO; postoperative endophthalmitis) following cataract surgery and those who did not ("controls") [25][26][27][28]. By considering the total reimbursements paid, they identified the increased cost of managing these complicated cases in both instances.…”

“…By considering the total reimbursements paid, they identified the increased cost of managing these complicated cases in both instances. In the case of CMO, this was an 85% increase vs "control" ($2720 vs $1470), and in the case of endophthalmitis, a 78% increase ($11,551 vs $6488) [27,28]. In these examples, the additional increased cost of complication-related CMO and endophthalmitis have been estimated in the USA system to be in the region of $1250 and $5000, respectively.…”

Peri-/Postoperative antientzündliche Therapie nach Kataraktoperation und refraktiver Chirurgie

“…Die Mehrkosten eines solchen postoperativen Makulaödems in den USA bezifferten Schmier et al 2016 auf ca. 85 % im Vergleich mit einer Kataraktoperation mit komplikationsfreiem postoperativen Verlauf [60]. Hochgerechnet auf 3 Mill.…”

Nepafenac in the Treatment of Ocular Inflammation Following Cataract Surgery (Pseudophakic Macular Oedema) – an Update

“…8,33 Once PMO becomes chronic, treatment has a high cost; prophylactic treatments significantly reduce these costs and reduce patient burden, particularly in those with preoperative diabetic macular oedema whose rates of PMO are substantially higher than those without it. 40…”