Garmo Vincent, Zhao Xiaohui, Ng Carmen D, Near Aimee, Banerji Tania, Wada Keiko, Oderda Gary, Brixner Diana, Biskupiak Joseph, Ali Ferhina S, Khanani Archad M, Menezes Alicia, Abbass Ibrahim M
Genentech, Inc., South San Francisco, California, USA.
IQVIA, Durham, North Carolina, USA.
J Health Econ Outcomes Res. 2024 Mar 29;11(1):94-102. doi: 10.36469/001c.93022. eCollection 2024.
The association of neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), and retinal vein occlusion (RVO) with functional status in the general Medicare population are not well established. This study examined patient-reported survey data linked with Medicare claims to describe the burden of these vision-threatening retinal diseases (VTRDs) among Medicare beneficiaries. Medicare Current Beneficiary Survey data linked with Medicare Fee-for-Service claims data from 2006 to 2018 were used in a nationally representative retrospective pooled cross-sectional population-based comparison study. Outcomes between community-dwelling beneficiaries with nAMD (n = 1228), DME (n = 101), or RVO (n = 251) were compared with community-dwelling beneficiaries without any VTRDs (n = 104 088), controlling for baseline demographic and clinical differences. Beneficiaries with a diagnosis of nAMD, DME, or RVO during the data year were included; those with other VTRDs were excluded. Outcomes included vision function and loss, overall functioning as assessed by difficulties with activities of daily living (ADLs) and instrumental ADLs (iADLs), anxiety/depression, falls, and fractures. Results: In patient cohorts with nAMD, DME, and RVO, approximately one-third (34.2%-38.3%) reported "a little trouble seeing" (vs 28.3% for controls), and 26%, 17%, and 9%, respectively, reported "a lot of trouble seeing/blindness" (vs 5% of controls). Difficulty walking and doing heavy housework were the most reported ADLs and iADLs, respectively. Compared with those without VTRDs, beneficiaries with nAMD had higher odds of diagnosed vision loss (odds ratio [OR], 5.39; 95% confidence interval, 4.06-7.16; P < .001) and difficulties with iADLs (odds ratio, 1.41; 95% confidence interval, 1.11-1.80; P = .005); no differences were observed for DME or RVO vs control. After adjusting for age, sex, race/ethnicity, poverty status, comorbidities, and other relevant covariates, nAMD, DME, and RVO were not significantly associated with anxiety/depression, falls, or fractures. Patients with nAMD or DME were more likely to report severe visual impairment than those without VTRDs, although only those with nAMD were more likely to be diagnosed with vision loss. Patients with nAMD continue to experience more vision impairment and worse functional status compared with a similar population of Medicare beneficiaries despite availability of therapies like antivascular endothelial growth factor to treat retinal disease.
在普通医疗保险人群中，新生血管性年龄相关性黄斑变性（nAMD）、糖尿病性黄斑水肿（DME）和视网膜静脉阻塞（RVO）与功能状态之间的关联尚未明确确立。本研究检查了与医疗保险理赔相关的患者报告调查数据，以描述医疗保险受益人中这些威胁视力的视网膜疾病（VTRD）的负担。将2006年至2018年医疗保险当前受益人调查数据与医疗保险按服务收费理赔数据相链接，用于一项具有全国代表性的回顾性汇总横断面人群对照研究。将患有nAMD（n = 1228）、DME（n = 101）或RVO（n = 251）的社区居住受益人组的结果与无任何VTRD的社区居住受益人组（n = 104088）进行比较，并对基线人口统计学和临床差异进行控制。纳入在数据年份诊断为nAMD、DME或RVO的受益人；排除患有其他VTRD的受益人。结果包括视力功能和丧失、通过日常生活活动（ADL）和工具性ADL（iADL）困难评估的整体功能、焦虑/抑郁、跌倒和骨折。结果：在患有nAMD、DME和RVO的患者队列中，约三分之一（34.2%-38.3%）报告“视物有点困难”（对照组为28.3%），分别有26%、17%和9%报告“视物非常困难/失明”（对照组为5%）。行走困难和做繁重家务分别是报告最多的ADL和iADL。与无VTRD者相比，患有nAMD的受益人诊断为视力丧失的几率更高（优势比[OR]，5.39；95%置信区间，4.06-7.16；P < 0.001），iADL困难的几率也更高（优势比，1.41；95%置信区间，1.11-1.80；P = 0.005）；DME或RVO与对照组相比未观察到差异。在调整年龄、性别、种族/族裔、贫困状况、合并症和其他相关协变量后，nAMD、DME和RVO与焦虑/抑郁、跌倒或骨折无显著关联。与无VTRD者相比，患有nAMD或DME的患者更可能报告严重视力损害，尽管只有患有nAMD的患者更可能被诊断为视力丧失。尽管有抗血管内皮生长因子等治疗视网膜疾病的疗法，但与类似的医疗保险受益人人群相比，患有nAMD的患者仍继续经历更多视力损害和更差的功能状态。
