Moulin Thiago A, Adjei Boakye Eric, Wirth Lorinette S, Chen Jiajing, Burroughs Thomas E, Vollman David E
Saint Louis University Center for Health Outcomes Research (SLUCOR), St. Louis, Missouri.
Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois; Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois.
Ophthalmol Retina. 2019 Apr;3(4):362-370. doi: 10.1016/j.oret.2018.11.014. Epub 2018 Dec 7.
To describe the treatment patterns and the predictors of different treatment standards in recently diagnosed diabetic macular edema (DME) patients in a nationally representative sample.
A retrospective cohort study using administrative claims data from January 1, 2007, through March 31, 2015. Patients were grouped into yearly cohorts.
A total of 96 316 patients were included.
Patients with a diagnosis of DME were identified using International Classification of Diseases, Ninth Edition, Clinical Modification, codes. Predictors of anti-vascular endothelial growth factor (VEGF) use and number of anti-VEGF injections per patient were assessed using generalized linear regression (logistic and negative binomial, respectively), and yearly trends in different treatments were analyzed with Mann-Kendall tests.
Predictors of anti-VEGF treatment and of anti-VEGF injections per patient and the changes in relative use of DME therapies per cohort.
Among those with any treatment, the odds of being prescribed anti-VEGF therapy increased by 700% from 2009 to 2014 and by 154% for those seen by a retina specialist. Those in the cohort of year 2014 received 3.5 times more injections than those in 2009, whereas those covered by Managed Medicare, Medicaid, and Medicare received 31%, 24%, and 11% less injections. Anti-VEGF were 11.6% of all DME treatments in 2009 increasing to 61.9% in 2014, while corticosteroids and focal laser procedures dropped from 6.1% to 3% and 75% to 24%, respectively. Procedures per patient (PPP) were much lower than those observed in clinical trials of anti-VEGF. Procedures per patient increased in the cases of aflibercept (from 1 in 2011 to 2.20 in 2014), bevacizumab (from 1.84 in 2009 to 3.40 in 2014), and ranibizumab (from 3.11 in 2009 to 4.48 in 2014), whereas applications of laser procedures and corticosteroids per patient remained roughly stable.
Year of diagnosis and being seen by a retina specialist were important predictors of receiving anti-VEGF therapy, and after one received such therapy, the number of additional injections was smaller for those with government-provided insurance. Anti-VEGF therapy has become a mainstay in DME treatment, with PPP, although relatively low, also increasing.
在全国代表性样本中描述近期诊断的糖尿病性黄斑水肿（DME）患者的治疗模式及不同治疗标准的预测因素。
一项回顾性队列研究，使用2007年1月1日至2015年3月31日的行政索赔数据。患者按年度队列分组。
共纳入96316例患者。
使用《国际疾病分类》第九版临床修订本代码识别诊断为DME的患者。使用广义线性回归（分别为逻辑回归和负二项回归）评估抗血管内皮生长因子（VEGF）使用的预测因素及每位患者抗VEGF注射次数，并通过曼-肯德尔检验分析不同治疗的年度趋势。
抗VEGF治疗及每位患者抗VEGF注射的预测因素，以及各队列中DME治疗相对使用情况的变化。
在接受任何治疗的患者中，2009年至2014年接受抗VEGF治疗的几率增加了700%，视网膜专科医生诊治的患者增加了154%。2014年队列中的患者接受的注射次数是2009年的3.5倍，而由管理式医疗保险、医疗补助和医疗保险覆盖的患者接受的注射次数分别减少了31%、24%和11%。抗VEGF治疗在2009年占所有DME治疗的11.6%，2014年增至61.9%，而皮质类固醇和局部激光治疗分别从6.1%降至3%和从75%降至24%。每位患者的治疗次数（PPP）远低于抗VEGF临床试验中的观察值。阿柏西普（从2011年的1次增至2014年的2.20次）、贝伐单抗（从2009年的1.84次增至2014年的3.40次）和雷珠单抗（从2009年的3.11次增至2014年的4.48次）的每位患者治疗次数增加，而每位患者的激光治疗和皮质类固醇应用次数大致保持稳定。
诊断年份和由视网膜专科医生诊治是接受抗VEGF治疗的重要预测因素，接受此类治疗后，有政府提供保险的患者额外注射次数较少。抗VEGF治疗已成为DME治疗的主要手段，尽管PPP相对较低，但也在增加。
