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Impacts and Costs of DED’s
Impact of DED’s
Visual impairment caused by Diabetes-related Retinopathy and Diabetes-related Macular Edema has significant impact on psychological well-being and quality of life 53, and limits employment, mobility, social functioning and independence53-55. Diabetes-related Retinopathy and Diabetes-related Macular Edema result in a significant economic burden on healthcare costs 54,56-58, and an increased need for formal and informal caregivers59 leading to productivity losses due to absence from labour force and opportunity costs associated to the support of informal care givers.
The Diabetes-related Retinopathy Barometer Study across 41 countries globally reported that 20% of patients with diabetes found their diabetes more difficult to manage due to loss in vision, 44% of patients with diabetes did not have, or did not use, written protocols for the management of diabetes related vision loss, 79% of respondents said their vision impairment due to Diabetes-related Retinopathy or Diabetes-related Macular Edema made everyday activities difficult, such as driving, working and cooking or cleaning their home, and in some cases impossible, 69% of those with Diabetes-related Macular Edema experienced days of poor physical and mental health, 27% of respondents either never discussed eye complications with their doctor or did so only after the onset of symptoms, 38% of patients said that long wait times for an appointment were a barrier to eye exams and 21% of ophthalmologists had not received specific training in the treatment and diagnosis of Diabetes-related Retinopathy and or Diabetes-related Macular Edema.
Early detection of eye disease and intervention can prevent sight loss and thereby avoid disability burden and provide substantial economic savings.
In Mexico it is estimated that screening for Diabetes-related Retinopathy would provide €20 million saving on healthcare, €34 million on informal care and €7 million in productivity in a year. In Ireland Diabetes-related Retinopathy screening has estimated savings of €5.4 million social care €3.6 million health care per year (Deloitte Access Economics 2011 ROI). In Australia DME indirect costs (not including health care or informal care owing to a lack of data) is calculated at $624.3 million per year. Direct medical costs of patients with type 2 diabetes in Switzerland is €2425 per patient per year 60. Costs associated with Diabetes-related Retinopathy tend to increase as Diabetes-related Retinopathy progresses. For a given year in Germany the total cost of Diabetes-related Retinopathy paid by society was €3.51 Billion 61.
A study in Taiwan reported the progression to advanced diabetes-related retinopathy was associated with higher costs compared to patients without progression, thus treatment intervention to halt or delay progression of Diabetes-related Retinopathy would prove beneficial.58 Additional studies in Taiwan show screening for Diabetes-related Retinopathy is both medically and economically worthwhile. Thus, annual screening for Diabetes-related Retinopathy among Chinese with type 2 diabetes should be conducted. Prevention programs aimed at improving eye care for patients with type 2 diabetes result in both substantial federal budgetary savings and highly cost-effective health care. Indeed a study in Sweden indicated that diagnosis and treatment brought down the cost associated with Diabetes-related Retinopathy 57, similarly in Sweden the severity of Diabetes-related Retinopathy and presence of Diabetes-related Macular Edema were associated with higher costs than Non Proliferative Diabetes-related Retinopathy and mild-moderate Diabetes-related Retinopathy, and total direct costs of Diabetes-related Retinopathy per year were calculated at €9.9 million57.
Medicare expenditure in the U.S.A. has also been reported to be higher in patients with diabetes with Non Proliferative Diabetes-related Retinopathy and Proliferative Diabetes-related Retinopathy compared to patients with diabetes without any Diabetes-related Retinopathy, expenditure was significantly greater in with Proliferative Diabetes-related Retinopathy patients compared to Non Proliferative Diabetes-related Retinopathy patients, thus suggesting delaying progression may be associated with decreased Medicare expenditures 62.