Healthcare resource use and costs of diabetic macular oedema for patients with antivascular endothelial growth factor versus a dexamethasone intravitreal implant in Korea: a population-based study

BMJ Open. 2019 Sep 20;9(9):e030930. doi: 10.1136/bmjopen-2019-030930.

Abstract

Objectives: To estimate the costs and healthcare resources of patients with diabetic macular oedema (DME) who received intravitreal antivascular endothelial growth factor (anti-VEGF) agents or a dexamethasone intravitreal implant (DEX-implant) in Korea.

Design: Retrospective cohort study.

Setting: The Korean National Health Insurance claim data from 1 January 2015 to 30 June 2017 were retrieved from the Health Insurance Review and Assessment Service.

Participants: Adult patients with DME who were diagnosed with diabetic retinopathy or DME and received ranibizumab, aflibercept or a DEX-implant in conjunction with intravitreal injection were included. Patients whose primary diagnoses were age-related macular degeneration or retinal vein occlusion were excluded.

Main outcome measures: Healthcare resource utilisation and costs related to DME in the 12-month postindex period.

Results: During the study period, 182 patients and 414 patients were identified in the anti-VEGF and DEX-implant groups, respectively, and there was no significant difference in the demographic characteristics between the two groups. The outpatient eye care-related medical costs were US$3002.33 for the anti-VEGF group vs US$2250.35 for the DEX-implant group (p<0.0001). After adjusting the relevant covariates based on the generalised linear model, the estimated outpatient eye care-related medical costs were 33% higher in the anti-VEGF group than in the DEX-implant group (p<0.0001, 95% CI 22% to 45%). The utilisation pattern of the two groups showed no significant difference except for the number of intravitreal injections, which was higher in the anti-VEGF group (2.69±2.29) than in the DEX-implant group (2.09±1.37, p<0.001).

Conclusion: The average annual eye-related medical cost of the DEX-implant group was significantly lower than that of the anti-VEGF group during the study period, which was mainly due to decreased utilisation of eye care-related injections. Further long-term studies are needed.

Keywords: Korea; agencies regulation; cost of illness; diabetic macular edema; population-based study; resource utilization.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Angiogenesis Inhibitors / administration & dosage*
  • Angiogenesis Inhibitors / economics*
  • Cohort Studies
  • Dexamethasone / administration & dosage*
  • Diabetic Retinopathy / complications
  • Diabetic Retinopathy / drug therapy*
  • Diabetic Retinopathy / economics*
  • Drug Implants / economics*
  • Facilities and Services Utilization / economics*
  • Facilities and Services Utilization / statistics & numerical data*
  • Female
  • Health Care Costs*
  • Health Resources / economics*
  • Health Resources / statistics & numerical data*
  • Humans
  • Intravitreal Injections / economics
  • Macular Edema / complications
  • Macular Edema / drug therapy*
  • Macular Edema / economics*
  • Male
  • Middle Aged
  • Ranibizumab / administration & dosage*
  • Ranibizumab / economics*
  • Receptors, Vascular Endothelial Growth Factor / administration & dosage*
  • Recombinant Fusion Proteins / administration & dosage*
  • Recombinant Fusion Proteins / economics*
  • Republic of Korea
  • Retrospective Studies
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors*
  • Young Adult

Substances

  • Angiogenesis Inhibitors
  • Drug Implants
  • Recombinant Fusion Proteins
  • Vascular Endothelial Growth Factor A
  • aflibercept
  • Dexamethasone
  • Receptors, Vascular Endothelial Growth Factor
  • Ranibizumab