Yearly Treatment Patterns for Patients with Recently Diagnosed Diabetic Macular Edema

Purpose: To describe the treatment patterns and the predictors of different treatment standards in recently diagnosed diabetic macular edema (DME) patients in a nationally representative sample.

Design: A retrospective cohort study using administrative claims data from January 1, 2007, through March 31, 2015. Patients were grouped into yearly cohorts.

Participants: A total of 96 316 patients were included.

Methods: Patients with a diagnosis of DME were identified using International Classification of Diseases, Ninth Edition, Clinical Modification, codes. Predictors of anti-vascular endothelial growth factor (VEGF) use and number of anti-VEGF injections per patient were assessed using generalized linear regression (logistic and negative binomial, respectively), and yearly trends in different treatments were analyzed with Mann-Kendall tests.

Main outcome measures: Predictors of anti-VEGF treatment and of anti-VEGF injections per patient and the changes in relative use of DME therapies per cohort.

Results: Among those with any treatment, the odds of being prescribed anti-VEGF therapy increased by 700% from 2009 to 2014 and by 154% for those seen by a retina specialist. Those in the cohort of year 2014 received 3.5 times more injections than those in 2009, whereas those covered by Managed Medicare, Medicaid, and Medicare received 31%, 24%, and 11% less injections. Anti-VEGF were 11.6% of all DME treatments in 2009 increasing to 61.9% in 2014, while corticosteroids and focal laser procedures dropped from 6.1% to 3% and 75% to 24%, respectively. Procedures per patient (PPP) were much lower than those observed in clinical trials of anti-VEGF. Procedures per patient increased in the cases of aflibercept (from 1 in 2011 to 2.20 in 2014), bevacizumab (from 1.84 in 2009 to 3.40 in 2014), and ranibizumab (from 3.11 in 2009 to 4.48 in 2014), whereas applications of laser procedures and corticosteroids per patient remained roughly stable.

Conclusions: Year of diagnosis and being seen by a retina specialist were important predictors of receiving anti-VEGF therapy, and after one received such therapy, the number of additional injections was smaller for those with government-provided insurance. Anti-VEGF therapy has become a mainstay in DME treatment, with PPP, although relatively low, also increasing.