Trends in the Prevalence and Treatment of Diabetic Macular Edema and Vision-Threatening Diabetic Retinopathy Among Commercially Insured Adults Aged <65 Years

Abstract

<p>  </p> <p><strong>Objective:</strong> Examine the ten-year trend in the prevalence and treatment of diabetic macular edema (DME) and vision-threatening diabetic retinopathy (VTDR) among commercially insured adults with diabetes.</p> <p><strong>Research Design and Methods</strong>: We analyzed the ten-year trend (2009–2018) in healthcare claims for adults 18–64 years using the IBM® MarketScan® Database, a national convenience sample of employer-sponsored health insurance. We included patients continuously enrolled in commercial fee-for-service health insurance for 24 months who had a diabetes ICD-9/10-CM code on ≥1 inpatient or ≥2 different day outpatient claims in the index year or previous calendar year. We used diagnosis and procedure codes to calculate the annual prevalence of patients with ≥1 claims for: 1) <em>any DME</em>, 2) either <em>DME/VTDR</em>, and 3) anti-vascular endothelial growth factor injections [anti-VEGF] and laser photocoagulation treatment, stratified by <em>any DME</em>, <em>VTDR with DME</em>, and <em>VTDR without DME</em>. We calculated Average Annual Percent Change (AAPC).</p> <p><strong>Results</strong>: From 2009–2018, there was an increase in the annual prevalence of patients with <em>DME/VTDR</em> (2.1% to 3.4%; AAPC=7.5%; p<0.001) and <em>any DME</em> (0.7% to 2.6%; AAPC=19.8%; p<0.001). There were sex differences in the annual prevalence of <em>DME/VTDR</em> and <em>any DME</em>, with males having a higher prevalence than females. Annual claims for anti-VEGF increased among those with <em>any DME</em> (327%) and <em>VTDR with DME</em> (206%); laser photocoagulation decreased among patients with <em>any DME </em>(-68%), <em>VTDR with DME </em>(-54%), and <em>VTDR without DME</em> (-62%). </p> <p><strong>Conclusions</strong>: Annual claims for <em>DME/VTDR</em> and anti-VEGF injections increased while laser photocoagulation decreased among commercially insured adults with diabetes.</p>