Transition from Laser to Intravitreal Injections for Diabetic Retinopathy: Hospital Utilization and Costs from an Extended Healthcare Perspective

Silvia Nanjala Walekhwa Hertzberg, Øystein K. Jørstad, Beáta Éva Petrovski, Ragnheidur Bragadottir, Leif Arthur Steffensen, Morten Carstens Moe, Emily A. Burger and Goran Petrovski ()
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Silvia Nanjala Walekhwa Hertzberg: Center for Eye Research, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, 0450 Oslo, Norway
Øystein K. Jørstad: Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
Beáta Éva Petrovski: Center for Eye Research, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, 0450 Oslo, Norway
Ragnheidur Bragadottir: Center for Eye Research, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, 0450 Oslo, Norway
Leif Arthur Steffensen: Human Resources, Oslo University Hospital, 0424 Oslo, Norway
Morten Carstens Moe: Center for Eye Research, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, 0450 Oslo, Norway
Emily A. Burger: Department of Health Management and Health Economics, University of Oslo, 0317 Oslo, Norway
Goran Petrovski: Center for Eye Research, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, 0450 Oslo, Norway

IJERPH, 2022, vol. 19, issue 19, 1-16

Abstract: Purpose: To describe the trends in hospital utilization and economic outcomes associated with the transition from laser to intravitreal injection (IVI) therapy for diabetic retinopathy (DR) at Oslo University Hospital (OUH), which provides the largest retina service in Norway. Methods: This descriptive study analyzed hospital administrative data and determined the average utilization and treatment proportions of laser therapy, IVIs and vitrectomy for each patient per year. The Chi-square test was used to compare resource use between treatment groups. From an extended healthcare perspective, the annual cost per patient was calculated using Norwegian tariff data from 2020 and the National Medication Price Registry for patients seen between 2010 and 2018. Bootstrapping was performed to generate 95% confidence intervals for the cost per patient per year. Results: Among the 1838 (41% female) patients treated for DR between 2005 and 2018, OUH provided on average 1.09 laser treatments per DR patient and 0.54 vitrectomies per DR patient in 2005, whose utilization declined to 0.54 and 0.05 treatments per DR patient, respectively, by 2018. Laser treatments declined from 64% to 10%, while vitrectomies declined from 32% to 1%. In contrast, IVI treatments increased from 4.5% to 89% of the total share, representing an average increase, from 0.08 injections per patient in 2005 to 4.73 injections per patient in 2018. Both the increasing number of DR patients and the shift in the type of treatment increased the economic costs of treating DR from a total of EUR 0.605 million (EUR 2935 per patient) in 2010 to EUR 2.240 million (EUR 3665 per patient) in 2018, with IVIs contributing considerably to these costs. Conclusions: Despite the decline in the use of vitrectomies, the transition from laser to IVI therapy for DR increased the healthcare resource utilization and economic costs of its treatment over the observed time. A main cost driver was the need for long-term IVIs, in addition to the drug cost itself. Trade-offs can be achieved through effective alternative IVI delivery or appropriate drug choice that balances patient needs with the economic burden of treating DR.

Keywords: diabetic retinopathy; intravitreal injections; laser treatment; vitrectomy; healthcare costs (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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