Clinical Ophthalmology (Mar 2016)
Treatment costs of cystoid macular edema among patients following cataract surgery
Abstract
Jordana K Schmier,1 David W Covert,2 Carolyn K Hulme-Lowe,1 Anmol Mullins,3 Emmanuel M Mahlis4 1Health Sciences, Exponent Inc., Alexandria, VA, 2Health Economics, 3Global Market Access, 4US Pharma Medical Affairs, Alcon Inc., Fort Worth, TX, USA Purpose: The current costs of treating cystoid macular edema (CME), a complication that can follow cataract surgery, are largely unknown. This analysis estimates the treatment costs for CME based on the recently released US Medicare data. Setting: Nationally representative database. Design: Retrospective analysis of the 2011 through 2013 Medicare 5% Beneficiary Encrypted Files. Methods: Beneficiaries who underwent cataract surgery were identified and stratified by diagnosis of CME (cases) or no diagnosis of CME (controls) within 6 months following surgery. Claims and reimbursements for ophthalmic care were identified. Subgroup analyses explored the rates of CME in beneficiaries based on the presence of selected comorbidities and by the type of procedure (standard vs complex). Total Medicare and ophthalmic costs for cases and controls are presented. The analysis explored the effect of considering diabetic macular edema (DME) and macular edema (ME) as exclusion criteria. Results: Of 78,949 beneficiaries with cataract surgery, 2.54% (n=2,003) were diagnosed with CME. One-third of beneficiaries had one or more conditions affecting retinal health (including diabetes), 4.5% of whom developed CME. The rate of CME, at 22.5%, was much higher for those patients with preoperative DME or ME. Ophthalmic charges were almost twice as high for cases compared with controls (US$10,410 vs $5,950); payments averaged 85% higher ($2,720 vs $1,470) (both P<0.0001). Conclusion: Substantial costs can be associated with CME; beneficiaries whose retinas are already compromised before cataract surgery face higher risk. Cost savings could be realized with the use of therapies that reduce the risk of developing CME. Future analyses could identify whether and to what extent comorbidities influence costs. Keywords: claims analysis, costs and cost analysis, cystoid macular edema, diabetic retinopathy
