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Alisa M. Shea, MPH; Lesley H. Curtis, PhD; Bradley G. Hammill, MS; Jonathan W. Kowalski, PharmD, MS; Arliene Ravelo, MPH; Paul P. Lee, MD, JD; Frank A. Sloan, PhD; Kevin A. Schulman, MD

Arch Ophthalmol. 2008;126(12):1748-1754.

Objective  To examine trends in resource use and the effect of incident diabetic macular edema (DME) on 1- and 3-year total direct medical costs in elderly patients.

Methods  We used a nationally representative 5% sample of Medicare beneficiaries from 2000 through 2004 to identify patients with incident DME and a control cohort of patients with diabetes mellitus but no history of retinal disease. We summed Medicare reimbursement amounts for all claims and applied generalized linear models to estimate the effect of DME on 1- and 3-year costs. We also examined the use of select imaging techniques and treatments.

Results  After adjusting for demographic characteristics and baseline comorbid conditions, DME was associated with 31% higher 1-year costs and 29% higher 3-year costs. There were significant shifts in the use of testing and treatment modalities. From 2000 to 2004, use of intravitreal injection increased from 1% to 13% of patients; use of optical coherence tomography increased from 2.5% to more than 40%. Use of laser photocoagulation decreased over time.

Conclusions  After adjusting for demographic variables and baseline comorbid conditions, new-onset DME was a significant independent predictor of total medical costs after 1 and 3 years. Diagnostic and treatment modalities used for DME have changed significantly.

Author Affiliations: Center for Clinical and Genetic Economics, Duke Clinical Research Institute (Ms Shea, Mr Hammill, and Drs Curtis and Schulman), Departments of Medicine (Drs Curtis and Schulman) and Ophthalmology (Dr Lee), Duke University School of Medicine and Center for Health Policy, and Department of Economics (Dr Sloan), Duke University, Durham, North Carolina; and Global Health Outcomes Research, Allergan, Inc, Irvine, California (Dr Kowalski and Ms Ravelo).

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