DME Economic Burden: Diabetes Prevalence, Retinopathy Risk, and Healthcare Costs

Welcome back to another Managed Healthcare Executive Between The Lines series. In "DME Economic Burden: Diabetes Prevalence, Retinopathy Risk, and Healthcare Costs," moderator Nicolas Yannuzzi, MD is joined by Nimesh Patel, MD to open the series on diabetic macular edema.

Dr. Yannuzzi opens the program by introducing himself, along with Dr. Patel, who focuses on adult and pediatric retina at Mass Eye and Ear and Boston Children's Hospital. He lays out three objectives: the economic burden of diabetes and DME, the treatment landscape and barriers to cost-effective care, and the PHOTON cost analysis.

Dr. Yannuzzi then frames the scale of the problem. Diabetes costs the United States about $640 billion each year, making it the nation's most expensive chronic condition to manage. He notes that the first-year cost of anti-VEGF therapy and office visits for diabetic eye disease can exceed $4,000. He adds that 48% to 64% of lifetime medical costs trace back to diabetes-related complications.

He turns next to prevalence. One in 10 adults worldwide has diabetes, and that share is expected to reach 1 in 8 by 2045 despite advances such as continuous glucose monitors and GLP-1 therapies. In the United States, 40 million people have diabetes and another 115 million adults have prediabetes.

Dr. Yannuzzi then defines DME. Diabetes damages the small vessels of the retina, which breaks down the blood-retinal barrier. Lipid, fluid, and exudation thicken the central retina and cause blurred vision and distortion. He explains that greater retinopathy severity worsens quality of life and can bring psychosocial stress, job loss, and financial hardship.

Finally, he reviews the eye disease burden. One in 3 patients with diabetes has some degree of retinopathy, and nearly 1 in 15 develops vision-threatening proliferative disease or DME. Within two decades, virtually all patients with type 1 diabetes and about 60% of those with type 2 develop some retinopathy. Dr. Yannuzzi says diabetic eye care makes up at least 80% of his practice in Miami.

The next episode in this series, "DME Treatment Landscape: Anti-VEGF Options and Prioritizing Eye Care in Diabetes," features the panel reviewing first-line care and weighing eye appointments against dialysis, amputations, and other demands.