Treatment Patterns and Economic Burden of Post Cataract Macular Edema

Abstract

Background: Post cataract macular edema (PCME) is a condition that affects 0.1 – 2.3% of patients following cataract surgery and can occur in the absence of risk factors and complications. Although 80% of patients experience spontaneous resolution after 3 to 12 months, in persistent cases, it can lead to permanent vision loss if left untreated. There is currently no widely accepted therapy or standardized treatment guidelines for PCME making treatment variable across patients. PCME has also been shown to significantly increase annual Medicare spending and ophthalmology related outpatient visits per case compared to those without the complication. To date, there have been no studies conducted on the treatment patterns of PCME and few studies have been conducted to quantify the relationship between PCME and costs.Objective: Our objective was to evaluate the treatment patterns and economic burden of PCME. We sought to achieve this objective by identifying the sequence of medications used for PCME and estimating the differences in healthcare resource utilization (HCRU) and costs among cataract surgery patients who developed PCME versus those who did not. Methods: Our study was a retrospective claims analysis that utilized data from the IBM® MarketScan® Commercial and Medicare Supplemental databases. The patient population consisted of adult patients ages 18 years or older who underwent cataract surgery, with date of surgery serving as the index date for each patient. The population was divided based on diagnosis of PCME (cases) or no diagnosis of PCME (controls) within a year after surgery. Each case was matched to three individuals from the control group using propensity score matching conditioned on age, geographic region, presence of diabetes, type of cataract surgery, and Charlson Comorbidity Index (CCI) score. Baseline demographic and clinical characteristics were assessed during a 12-month pre-index period. Analysis of treatment patterns was performed by combining medication claims for each PCME patient and summarizing the distribution of which medications were used for each line of therapy. Economic burden was assessed by comparing the mean number and costs (sum of patient out of pocket costs and payer cost) of unique eye-related outpatient visits, optical coherence tomography (OCT) imaging scans, and ophthalmic medications between the two groups of patients using linear regression models. All models were adjusted for age, geographical region, presence of diabetes, complexity of cataract surgery, number of cataract surgeries, and CCI score category. Results: Of the 98,050 patients who had cataract surgery and met the eligibility criteria, 2.5% (n= 2430) were diagnosed with PCME and met our prespecified criteria. Analysis of treatment patterns resulted in 27 different combinations of medications across six treatment lines. The most common first line treatments received were topical steroid drops (30%), topical nonsteroidal anti-inflammatory drug (NSAID) drops (27%), and intraocular or periocular injectable steroids (15%). Patients in the PCME group had significantly higher amounts and costs of healthcare resource use across all categories compared to matched controls. On average they had an excess of 6 eye related outpatient office visits (95% CI: 5.7 – 6.2) which resulted in additional $3,897 (95% CI: $3,475 - $4,319) total costs. Patients also filled 3 more ophthalmology related outpatient prescription medications (95% CI: 2.8 – 3.2), adding $371 in total cost (95% CI: $332 - $410). Conclusions: Treatment pattern results show large variability in treatments and timing of use for PCME, specifically around injectable treatments and combination therapy. Although current literature supports a stepwise treatment approach with injectable treatments reserved as last line alternatives, this was not observed. Additionally, we found significantly higher heath care resource use and financial burden for both patients and payers when comparing PCME patients to non-PMCE controls. Eye related outpatient office visits were found to be a main driver of excess economic burden for these individuals.