Jeon Ha-Lim, Lee Hyesung, Yoon Dongwon, Lee Yeonkyung, Kim Jae Hui, Jee Donghyun, Shin Ju-Young
School of Pharmacy, Sungkyunkwan University, Suwon, South Korea.
Bayer Korea Ltd, Seoul, South Korea.
BMJ Open. 2020 Dec 29;10(12):e042484. doi: 10.1136/bmjopen-2020-042484.
To examine healthcare resource utilisation (HRU) and direct medical costs for patients with diabetic macular oedema (DME) treated with antivascular endothelial growth factor (anti-VEGF) in Korea by comparing with those for (1) patients with diabetes mellitus (DM) without retinopathy and (2) patients with neovascular age-related macular degeneration (nAMD) treated with anti-VEGF.
Retrospective cohort study.
The Korean National Health Insurance (NHI) database from 1 January 2014 to 31 December 2016.
We identified 1398 patients older than 30 years of age who received anti-VEGF treatment for DME in 2015 after excluding patients who had a diagnosis of nAMD in 2015 and any cancer in the preceding year.
One-year healthcare resource use and direct medical costs of patients with DME treated with anti-VEGF.
In total, 1398 patients with DME receiving anti-VEGF, 12 813 patients with DM without retinopathy and 12 222 patients with nAMD receiving anti-VEGF were identified. Hospital admissions and outpatient visits were highest in patients with DME, while the number of licensed anti-VEGF injections in those with DME was about half that of those with nAMD (2.1 vs 3.9 per patient per year). Mean 1-year medical costs were also higher in patients with DME (US$6723) than in those with DM without retinopathy (US$2687) and nAMD (US$4980). In a multivariable analysis with matched cohorts, DME was associated with 66% higher medical costs for comorbid diseases (adjusted OR (aOR), 1.66; 95% CI 1.45 to 1.90) and 50% lower anti-VEGF injections (aOR, 0.50; 95% CI 0.46 to 0.54) compared with nAMD.
The overall HRU and economic burden for DME treated with anti-VEGF were higher than for DM without retinopathy or for nAMD treated with anti-VEGF. Meanwhile, the lower number of licensed anti-VEGF injections compared with nAMD may reflect a potential lack of ophthalmological treatment for DME supported by the NHI in Korea.
通过与以下两类患者进行比较，研究韩国接受抗血管内皮生长因子（抗VEGF）治疗的糖尿病性黄斑水肿（DME）患者的医疗资源利用（HRU）情况及直接医疗费用：（1）无视网膜病变的糖尿病（DM）患者；（2）接受抗VEGF治疗的新生血管性年龄相关性黄斑变性（nAMD）患者。
回顾性队列研究。
韩国国民健康保险（NHI）2014年1月1日至2016年12月31日的数据库。
我们纳入了1398例年龄大于30岁、于2015年接受DME抗VEGF治疗的患者，排除了2015年诊断为nAMD及前一年患有任何癌症的患者。
接受抗VEGF治疗的DME患者的一年医疗资源使用情况及直接医疗费用。
共确定了1398例接受抗VEGF治疗的DME患者、12813例无视网膜病变的DM患者以及12222例接受抗VEGF治疗的nAMD患者。DME患者的住院次数和门诊就诊次数最多，而DME患者的抗VEGF注射剂使用量约为nAMD患者的一半（每年每位患者2.1次 vs 3.9次）。DME患者的平均一年医疗费用（6723美元）也高于无视网膜病变的DM患者（2687美元）和nAMD患者（4980美元）。在匹配队列的多变量分析中，与nAMD相比，DME患者的合并症医疗费用高66%（调整后比值比（aOR），1.66；95%置信区间1.45至1.90），抗VEGF注射剂使用量低50%（aOR，0.50；95%置信区间0.46至0.54）。
抗VEGF治疗的DME患者的总体医疗资源利用和经济负担高于无视网膜病变的DM患者或抗VEGF治疗的nAMD患者。同时，与nAMD相比，DME患者的抗VEGF注射剂使用量较低，这可能反映出韩国国民健康保险对DME眼科治疗的支持可能不足。
