Trends in the Care of Diabetic Macular Edema: Analysis of a National Cohort.

Brian L Vanderbeek,Purak C Parikh,Liyuan Ma,Neepa Shah,Gianni Virgili

doi:10.1371/journal.pone.0149450

Brian L Vanderbeek, Purak C Parikh + Show 3 more

Open Access

https://doi.org/10.1371/journal.pone.0149450

Copy DOI

Abstract

PurposeTo evaluate how the monitoring and treatment for diabetic macular edema (DME) has changed in a national sample.DesignRetrospective cohort study.MethodsSetting: Administrative medical claims data from a large, national U.S. insurer. Study population: Beneficiaries of a U.S. insurance company. Observation procedures: All incident cases of DME were found. Those in years 2002/3, 2006 and 2010 were followed for a 2-year observation period and those from 2009, 2010 and 2011 for a 1-year observation period. Main Outcome Measures: Types and frequencies of treatment were tallied and compared over each of the cohorts.ResultsTwo-year cohorts had 233, 251 and 756 patients in 2002/3, 2006 and 2010 respectively. One-year cohorts had 1002, 1119 and 1382 patients in 2009, 2010 and 2011, respectively. Both percentage of patients receiving therapy and number of treatments given increased across the 2-year cohorts for both focal laser and anti-vascular endothelial growth factor (anti-VEGF) (p<0.001). The highest use of anti-VEGF agents in any of the cohorts was in the 2011 1-year group that only averaged 3.78 injections. Focal laser was used 2.5x as frequently as anti-VEGF injections in the most recent cohorts with only a high of 14.0% of DME patients receiving anti-VEGF therapy in any of the cohorts.ConclusionRegardless of treatment modality (laser or injection) DME patients received vastly fewer treatments than patients in randomized control trials. Despite the proven superior visual outcomes of anti-VEGF agents over focal laser in DME, focal laser was still used more frequently.

Highlights

Macular edema is a significant cause of poor vision in those with diabetic retinopathy.[1]
One-year cohorts had 1002, 1119 and 1382 patients in 2009, 2010 and 2011, respectively. Both percentage of patients receiving therapy and number of treatments given increased across the 2-year cohorts for both focal laser and anti-vascular endothelial growth factor (p
Focal laser was used 2.5x as frequently as anti-VEGF injections in the most recent cohorts with only a high of 14.0% of diabetic macular edema (DME) patients receiving anti-VEGF therapy in any of the cohorts

Summary

Introduction

Macular edema is a significant cause of poor vision in those with diabetic retinopathy.[1]. Multiple clinical trials have been performed and all have demonstrated that the addition of intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents to the care of DME improves visual acuity far better than focal laser alone.[2,3,4,5,6,7]. Curtis et al used Medicare claims data to show that anti-VEGF use for AMD increased dramatically from 2006–2008, which paralleled an increase in office visits and a decrease in photodynamic therapy and thermal laser treatments.[8] Yet, concerns arose when later studies observed a high rate of antiVEGF discontinuation, and showed that even those who stayed on therapy received a lower frequency of injections than the monthly protocol thought to have optimal outcomes as demonstrated by major AMD randomized clinical trials.[9,10,11]

Objectives

Results

Conclusion