Uveitic Macular Edema Increases Costs Among Patients With Noninfectious Uveitis

Uveitic macular edema (UME) is a common complication in patents with noninfectious uveitis (NIU), and the symptoms of UME can carry a significant burden for both patients and payers. A review published in BMJ Open Ophthalmology showed increased health care costs and vision loss in patients with UME versus those without it.

NIU, a condition that causes uveal tract inflammation, is the most common type of uveitis in the United States and can have significant long-term clinical consequences. Patients with NIU can experience a lower quality of life and become unable to work due to the symptoms of NIU, which include vision loss. The condition is also associated with optic nerve disease, glaucoma, and cataracts, all of which can impact patients' quality of life.

The most prominent complication associated with it is UME. In UME, the blood-retinal barrier breaks down, causing fluid to accumulate and the retina to thicken. It is the main cause of vision loss in NIU patients, but there are currently no FDA-approved therapies to treat UME specifically.

Local corticosteroids as part of NIU management can indirectly treat UME and control inflammation, but long-term use of corticosteroids is associated with a variety of side effects such as cataracts, glaucoma and increased intraocular pressure for local applications; systemic corticosteroids are associated with hypertension, diabetes, osteoporosis, and atherosclerosis. After corticosteroid failure, options for UME management include immunosuppressants, biological therapies, and vitreoretinal surgery.

Despite its potential quality-of-life and economic effects, there is little real-world data on the costs and burden of UME as a standalone condition. The current study pulled employer-sourced and health plan-sourced data from the IBM MarketScan Commercial Subset, which includes the portion of treatment costs paid by employers and out-of-pocket costs for patients, to characterize UME patients and the costs associated with UME in the US.

The retrospective cohort study first stratified patients into 2 main groups. A UME cohort included patients with NIU and an observed diagnosis of UME at any time, and an NIU without UME cohort included patients with NIU but no observed diagnosis of UME at any time. One subgroup in the UME cohort included patients with a recorded diagnosis of UME during the study period, and a second subgroup included those with a recorded diagnosis of UME during the study period who also received a local steroid injection (LSI) during the study period.

A total of 36,322 NIU patients were identified, and 3301 (9.1%) were part of the UME cohort. Of those patients, 1577 (47.8%) were diagnosed with UME during the study period, and 367 (23.2%) had an LSI during the study period. The mean patient age was 50.1 years.Hypertension, rheumatoid arthritis, collagen vascular disease, and obesity were the most common comorbidities at baseline in the overall cohort.

Patients in the UME cohort experienced vision loss at a higher rate (5.7%) than those without UME (2.2%). Those with UME who received an LSI during the study period showed slightly higher rates (7.9%) than the UME cohort overall. The UME group received any NIU-related treatment more often compared with those with NIU alone (64.6% vs 45.0%, respectively). Patients who had an LSI during the study period drove the overall rate of treatment up in the UME cohort.

Where cost is concerned, patients with UME saw higher mean all-cause health care costs per patient per year (PPPY). The mean cost in the UME cohort was $19,851 versus $16,188 in the non-UME cohort. The cost difference was mainly driven by outpatient costs, which were a mean of $8421 in the UME group versus $6382 in the non-UME cohort; and pharmacy costs, which totaled $8329 for UME patients compared with $6421 in NIU patients without UME. Patients with bilateral UME saw the highest costs PPPY at $24,162. Study authors suspect that the high frequency of bilateral disease in UME, especially in the study subgroup with LSI 27.4% and 50.1%, respectively), may have driven up the cost.

Researchers also assessed health care costs with vision loss in a group of 90,974 patients with an NIU diagnosis and found that vision loss also increased all-cause health care costs, most of which were not eye-related. As vision loss worsened, costs increased, and patients with an indicator of blindness had mean medical costs of $53 767 PPPY — $48 560 of which was not eye related.

This is the first study to assess the economic burden of UME specifically in the insured US population that the authors know of, so there is little for comparison with other research. However, the significant economic burden of the condition suggests there is an unmet need for targeted management of UME, the authors conclude. There are currently no guidelines for UME treatment, and NIU guidelines include limited guidelines for UME management.

“The substantial burden of UME observed in the current study, particularly associated with bilateral NIU and vision loss, goes beyond the existing burden of NIU and highlights the need for increased awareness and effective and timely management of the condition,” the authors wrote.

Reference

Hariprasad SM, Joseph G, Gagnon-Sanschagrin P, et al. Healthcare costs among patients with macular oedema associated with non-infectious uveitis: a US commercial payer’s perspective. BMJ Open Ophthalm. Published online November 10, 2021. doi:10.1136/bmjophth-2021-000896