Background and Importance Treatment options for diabetic macular edema (DME) include intravitreal anti-vascular endothelial growth factor (anti-VEGF) drugs and dexamethasone implant (DEX-implant), both with their own treatment pros and cons. To date, few studies have examined the healthcare resource utilisation and medical costs associated with these two drug classes for DME treatment.

Aim and Objectives To compare DME-related healthcare utilisation and medical costs of patients with DME receiving intravitreal anti-VEGF drugs or DEX-implant in clinical practice.

Material and Methods We conducted a retrospective cohort study by analysing the largest multi-institutional electronic medical records database in Taiwan. We included adult patients with DME newly receiving intravitreal anti-VEGF drugs (ranibizumab and aflibercept), and DEX-implant during 2017–2021. To ensure the homogeneous comparisons, we apply the 1:1 propensity score matching approach to control the potential confounders. The primary outcome was the 1-year DME-related healthcare utilisation and direct medical cost per patient with DME that was reimbursed by Taiwan’s National Health Insurance. We used the mean ± standard deviation to present descriptive statistics and applied t-tests to determine statistical differences between the two treatment groups for continuous outcomes.

Results We included a total of 214 patients with DME newly receiving intravitreal anti-VEGF drugs (n=107) and DEX-implant (n=107). The mean age (67.0±9.0 vs. 67.0±12.8 years) and HbA1c (7.6±1.1 vs. 7.7±1.3%) and eGFR levels (70.5±26.7 vs. 70.1±22.0 mL/min/1.73m2) were similar for the two treatment groups. The average outpatient medical cost per person for eye care was lower for the DEX-implant group (NTD 81,838± 54,752 vs. 105,109±62,481; p=0.004), compared to the anti-VEGF drug group during the 1-year follow-up period. The average intravitreal injections per person for eye care were lower for the DEX-implant group (1.8±1.4 vs. 3.9±2.6; p<0.001), compared to the anti-VEGF group, during the 1-year follow-up period. However, patients with DEX-implant received more pneumotonometry (3.3±3.7 vs. 2.0±2.6; p=0.004), compared to the anti-VEGF drug group, during the 1-year follow-up period.

Conclusion and Relevance Compared to the anti-VEGF drug group, DME patients with intravitreal DEX-implant were associated with lower average direct outpatient medical costs for eye care and lower number of intravitreal injections during the first year of treatment in Taiwan.

Conflict of Interest No conflict of interest.