College of Pharmacy, Ewha Womans University, Seoul, The Republic of Korea.
Department of Ophthalmology, Soonchunhyang University Hospital Seoul, Yongsan-gu, The Republic of Korea.
BMJ Open. 2019 Sep 20;9(9):e030930. doi: 10.1136/bmjopen-2019-030930.
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.
Retrospective cohort study.
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.
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.
Healthcare resource utilisation and costs related to DME in the 12-month postindex period.
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).
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.
评估在韩国接受玻璃体内抗血管内皮生长因子（anti-VEGF）药物或地塞米松玻璃体内植入物（DEX-implant）治疗的糖尿病性黄斑水肿（DME）患者的成本和医疗资源。
回顾性队列研究。
从健康保险审查和评估服务处检索了 2015 年 1 月 1 日至 2017 年 6 月 30 日的韩国国家健康保险索赔数据。
纳入诊断为糖尿病性视网膜病变或 DME 且接受雷珠单抗、阿柏西普或 DEX-implant 联合玻璃体内注射的成年 DME 患者。排除原发性诊断为年龄相关性黄斑变性或视网膜静脉阻塞的患者。
索引后 12 个月内与 DME 相关的医疗资源利用和成本。
在研究期间，抗 VEGF 组和 DEX-implant 组分别确定了 182 例和 414 例患者，两组之间的人口统计学特征无显著差异。抗 VEGF 组的门诊眼科相关医疗费用为 3002.33 美元，DEX-implant 组为 2250.35 美元（p<0.0001）。基于广义线性模型调整相关协变量后，抗 VEGF 组的估计门诊眼科相关医疗费用比 DEX-implant 组高 33%（p<0.0001，95%CI 22%至 45%）。两组的利用模式除玻璃体内注射次数外无显著差异，抗 VEGF 组（2.69±2.29）高于 DEX-implant 组（2.09±1.37，p<0.001）。
在研究期间，DEX-implant 组的年均眼部相关医疗费用明显低于抗 VEGF 组，这主要是由于减少了眼部相关注射的使用。需要进一步开展长期研究。
