Productivity Loss Among Patients with Diabetic Macular Edema in Two Eyes: A Retrospective Commercial Claims Analysis in the United States

Abstract

Background: Diabetic retinopathy (DR) is a leading cause of blindness in the US and its prevalence is increasing due to the rising incidence of diabetes. Diabetes macular edema (DME) is a common complication of DR that can cause central vision loss and impact workplace productivity. However, to the best of our knowledge no studies to date have assessed missed worktime following a diagnosis of DME in both eyes. With the implementation of the International Classification of Diseases, 10th revision (ICD-10) codes that differentiate laterality of the disease enable study of two-eye DME population specifically.Objective: To quantify productivity loss due to absenteeism in the year following diagnosis among commercially insured non-elderly adults with newly diagnosed DME in two eyes in the US. Methods: We conducted a retrospective cohort study using MarketScan health insurance claims data to identify DME diagnoses, linked with the Health and Productivity Management database to capture reported productivity loss. Incident two-eye DME patients were identified between January 1st, 2018 to December 31st, 2019 and followed for up to one year after diagnosis. One-year productivity loss after two-eye DME diagnosis was calculated as the sum of days missed due to nonrecreational absenteeism, short-term, and long-term disability during the one-year follow-up period. The indirect cost attributable to workdays lost was calculated assuming an 8-hour workday and using the US average hourly wage (March 2023). A multivariable logistic regression was performed to describe the association between having any workdays lost and age, sex, region, health plan type, CCI score, receipt of anti-vascular endothelial growth factor (anti-VEGF) therapy, and frequency of anti-VEGF therapy. Results: In the year following two-eye DME diagnosis, on average, patients with DME in both eyes lost 7.7 workdays (95% CI (5.13, 10.53)), corresponding to an indirect cost of $2,044 (95% CI ($1,362 - $2,795)). Region and the receipt of anti-VEGF therapy were associated with reporting any workdays lost among newly diagnosed two-eye DME patients, with almost 80% higher odds of having any workdays lost in patients who received anti-VEGF therapy, likely due to more severe disease, compared to those who didn’t receive the therapy (OR=1.80, 95% CI: (1.05, 3.06)). Discussion: We found that newly diagnosed two-eye DME patients have an average of 7.7 workdays lost, and the receipt of anti-VEGF therapy is the observed clinical characteristics from the claims data that is associated with workdays lost. However, the results may not be generalizable to the broader US population as this analysis primarily assessed full-time employees with employer-sponsored private health insurance and disability benefits.