Visual impairment caused by Diabetic Retinopathy and Diabetic Macular Edema has significant impact on psychological well-being and quality of life 5, and limits employment, mobility, social functioning and independence 5-7. Diabetic Retinopathy and Diabetic Macular Edema result in a significant economic burden on healthcare costs 6,8-10, and an increased need for formal and informal caregivers 11 leading to productivity losses due to absence from labour force and opportunity costs associated to the support of informal care givers.
Impacts and Costs of Diabetic Eye Disease
Impacts and Costs of Diabetic Eye Disease
The Diabetic Retinopathy Barometer Study across 41 countries globally reported that 20% of diabetic patients found their diabetes more difficult to manage due to loss in vision, 44% of diabetic patients did not 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 Diabetic Retinopathy or Diabetic 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 Diabetic 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 Diabetic Retinopathy and or Diabetic 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 Diabetic Retinopathy would provide €20 million saving on healthcare, €34 million on informal care and €7 million in productivity in a year. In Ireland Diabetic 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 type 2 diabetics in Switzerland is €2425 per patient per year 12. Costs associated with Diabetic Retinopathy tend to increase as Diabetic Retinopathy progresses. For a given year in Germany the total cost of Diabetic Retinopathy paid by society was €3.51 Billion 13. A study in Taiwan reported the progression to advanced diabetic retinopathy was associated with higher costs compared to patients without progression, thus treatment intervention to halt or delay progression of Diabetic Retinopathy would prove beneficial.10 Additional studies in Taiwan show screening for Diabetic Retinopathy is both medically and economically worthwhile. Thus, annual screening for Diabetic 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 Diabetic Retinopathy 9, similarly in Sweden the severity of Diabetic Retinopathy and presence of Diabetic Macular Edema were associated with higher costs than Non Proliferative Diabetic Retinopathy and mild-moderate Diabetic Retinopathy, and total direct costs of Diabetic Retinopathy per year were calculated at €9.9 million9. Medicare expenditure in the U.S.A. has also been reported to be higher in diabetic patients with Non Proliferative Diabetic Retinopathy and Proliferative Diabetic Retinopathy compared to diabetic patients without any Diabetic Retinopathy, expenditure was significantly greater in with Proliferative Diabetic Retinopathy patients compared to Non Proliferative Diabetic Retinopathy patients, thus suggesting delaying progression may be associated with decreased Medicare expenditures 14.