Incremental Economic Burden Associated with Exudative Age-related Macular Degeneration: a Population-based Study

Overview

Journal BMC Health Serv Res

Publisher Biomed Central

Specialty Health Services

Date 2019 Nov 14

PMID 31718629

Citations 19

Authors

Siin Kim

Sang Jun Park

Seong Jun Byun

Kyu Hyung Park

Hae Sun Suh

Affiliations

Soon will be listed here.

Abstract

Background: The exudative age-related macular degeneration (AMD) causes considerable healthcare costs for patients and healthcare system, which are expected to grow as the population ages. The objective of this study was to assess the incremental economic burden of exudative AMD by comparing total healthcare costs between the exudative AMD group and non-AMD group to understand economic burden related to exudative AMD.

Methods: This retrospective cohort study used the National Health Insurance Service database including the entire Korean population. Exudative AMD group included individuals with at least one claim for ranibizumab and one claim using the registration code for exudative AMD (V201). Non-AMD group was defined as individuals without any claims regarding the diagnostic code of H35.3 or ranibizumab. The exudative AMD group and non-AMD group were matched using a propensity-score model. Incremental healthcare resource utilization and healthcare costs were measured during a one-year follow-up by employing econometric models: ordinary least squares (OLS) with log transformation and heteroscedastic retransformation; and generalized linear model (GLM) with a log link function and gamma distribution.

Results: A total of 7119 exudative AMD patients were matched to 7119 non-AMD patients. The number of outpatient visits was higher in the exudative AMD group (P-value < 0.0001), while the length of hospitalization was shorter in exudative AMD group (P-value < 0.0001). Exudative AMD patients had total costs 2.13 times (95%CI, 2.08-2.17) greater than non-AMD group using OLS, and total costs 4.06 times (95%CI, 3.82-4.31) greater than non-AMD group using GLM. Annual incremental total costs were estimated as $5519 (OLS) and $3699 (GLM).

Conclusions: Exudative AMD was associated with significantly increased healthcare costs compared to the non-AMD group. Attention is needed to manage the socioeconomic burden of exudative AMD.

Citing Articles

Recurrence of neovascular age-related macular degeneration after discontinuation of modified treat and extend treatment.

Lee J, Choi J, Yu S, Kim K Sci Rep. 2025; 15(1):8952.

PMID: 40089567 DOI: 10.1038/s41598-025-92832-w.

Burdens and trends of age-related macular degeneration at global, regional, and national levels,1990-2021: findings from the 2021 global burden of disease study.

Zhou Y, Jia W, Song J, Li M, Dai W, Zou J Eye (Lond). 2025; .

PMID: 39962207 DOI: 10.1038/s41433-025-03686-5.

Importance of Choriocapillaris Replacement in Therapeutic Strategies for Age-Related Macular Degeneration.

Burton E, Tovell V, Coffey P Adv Exp Med Biol. 2025; 1468:389-393.

PMID: 39930227 DOI: 10.1007/978-3-031-76550-6_64.

Blue Light-Induced Mitochondrial Oxidative Damage Underlay Retinal Pigment Epithelial Cell Apoptosis.

Abdouh M, Chen Y, Goyeneche A, Burnier M Int J Mol Sci. 2024; 25(23).

PMID: 39684332 PMC: 11641757. DOI: 10.3390/ijms252312619.

Off-Label Use of Bevacizumab in Patients Diagnosed with Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis.

Estarreja J, Mendes P, Silva C, Camacho P, Mateus V Pharmaceuticals (Basel). 2024; 17(8).

PMID: 39204105 PMC: 11357420. DOI: 10.3390/ph17081000.

References

Kim J, Lee D, Chang Y, Kim J, Kim C . Twelve-month outcomes of treatment using ranibizumab or aflibercept for neovascular age-related macular degeneration: a comparative study. Graefes Arch Clin Exp Ophthalmol. 2016; 254(11):2101-2109. DOI: 10.1007/s00417-016-3353-7. View

Lee J, Lee J, Park S, Shin S, Kim K . Cohort Profile: The National Health Insurance Service-National Sample Cohort (NHIS-NSC), South Korea. Int J Epidemiol. 2016; 46(2):e15. DOI: 10.1093/ije/dyv319. View

Park S, Lee J, Woo S, Ahn J, Shin J, Song S . Age-related macular degeneration: prevalence and risk factors from Korean National Health and Nutrition Examination Survey, 2008 through 2011. Ophthalmology. 2014; 121(9):1756-65. DOI: 10.1016/j.ophtha.2014.03.022. View

Austin P . Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med. 2009; 28(25):3083-107. PMC: 3472075. DOI: 10.1002/sim.3697. View

Cruess A, Zlateva G, Xu X, Soubrane G, Pauleikhoff D, Lotery A . Economic burden of bilateral neovascular age-related macular degeneration: multi-country observational study. Pharmacoeconomics. 2007; 26(1):57-73. DOI: 10.2165/00019053-200826010-00006. View

Kim J, Chang Y, Kim J . NATURAL COURSE OF PATIENTS DISCONTINUING TREATMENT FOR AGE-RELATED MACULAR DEGENERATION AND FACTORS ASSOCIATED WITH VISUAL PROGNOSIS. Retina. 2017; 37(12):2254-2261. DOI: 10.1097/IAE.0000000000001494. View

Normand S, Landrum M, Guadagnoli E, Ayanian J, Ryan T, Cleary P . Validating recommendations for coronary angiography following acute myocardial infarction in the elderly: a matched analysis using propensity scores. J Clin Epidemiol. 2001; 54(4):387-98. DOI: 10.1016/s0895-4356(00)00321-8. View

Manning W, Mullahy J . Estimating log models: to transform or not to transform?. J Health Econ. 2001; 20(4):461-94. DOI: 10.1016/s0167-6296(01)00086-8. View

Brown M, Brown G, Sharma S, Busbee B . Quality of life associated with visual loss: a time tradeoff utility analysis comparison with medical health states. Ophthalmology. 2003; 110(6):1076-81. DOI: 10.1016/S0161-6420(03)00254-9. View

10.

Lim L, Mitchell P, Seddon J, Holz F, Wong T . Age-related macular degeneration. Lancet. 2012; 379(9827):1728-38. DOI: 10.1016/S0140-6736(12)60282-7. View

11.

Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi J . Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005; 43(11):1130-9. DOI: 10.1097/01.mlr.0000182534.19832.83. View

12.

Song S, Jung C, Song Y, Park C, Kwon H, Cha B . Background and data configuration process of a nationwide population-based study using the korean national health insurance system. Diabetes Metab J. 2014; 38(5):395-403. PMC: 4209354. DOI: 10.4093/dmj.2014.38.5.395. View

13.

Mullahy J . Much ado about two: reconsidering retransformation and the two-part model in health econometrics. J Health Econ. 1998; 17(3):247-81. DOI: 10.1016/s0167-6296(98)00030-7. View

14.

Park S, Kwon K, Choi N, Park K, Woo S . Prevalence and Incidence of Exudative Age-Related Macular Degeneration in South Korea: A Nationwide Population-Based Study. Ophthalmology. 2015; 122(10):2063-70.e1. DOI: 10.1016/j.ophtha.2015.06.018. View

15.

Lee Y, Kwon S, Hong S, Nam J, Song H, Lee J . Health Care Utilization and Direct Costs in Mild, Moderate, and Severe Adult Asthma: A Descriptive Study Using the 2014 South Korean Health Insurance Database. Clin Ther. 2017; 39(3):527-536. DOI: 10.1016/j.clinthera.2017.01.025. View

16.

Lotery A, Xu X, Zlatava G, Loftus J . Burden of illness, visual impairment and health resource utilisation of patients with neovascular age-related macular degeneration: results from the UK cohort of a five-country cross-sectional study. Br J Ophthalmol. 2007; 91(10):1303-7. PMC: 2000983. DOI: 10.1136/bjo.2007.116939. View

17.

Bonastre J, Le Pen C, Anderson P, Ganz A, Berto P, Berdeaux G . The epidemiology, economics and quality of life burden of age-related macular degeneration in France, Germany, Italy and the United Kingdom. Eur J Health Econ. 2004; 3(2):94-102. DOI: 10.1007/s10198-002-0104-y. View

18.

Kume A, Ohshiro T, Sakurada Y, Kikushima W, Yoneyama S, Kashiwagi K . Treatment Patterns and Health Care Costs for Age-Related Macular Degeneration in Japan: An Analysis of National Insurance Claims Data. Ophthalmology. 2016; 123(6):1263-8. DOI: 10.1016/j.ophtha.2016.01.042. View

19.

Ambati J, Ambati B, Yoo S, Ianchulev S, Adamis A . Age-related macular degeneration: etiology, pathogenesis, and therapeutic strategies. Surv Ophthalmol. 2003; 48(3):257-93. DOI: 10.1016/s0039-6257(03)00030-4. View