Anti-VEGF Use for Diabetic Eye Diseases Increased 200% in Last Decade

Christopher Holliday, PhD, MPH

An analysis of data from commercially insured adults is providing clinicians with an overview of trends in the prevalence and treatment of multiple forms of diabetic eye diseases among those less than 65 years old in the US.

Using the IBM MarketScan Database for a period lasting from 2009-2018, results of the analysis indicate there has been an increase in annual prevalence of both diabetic macular edema (DME) and vision-threatening diabetic retinopathy during the study period, with results also pointing to a shift in preferred therapeutic approach as use of anti-VEGF injections in DME increased 300%.

“From 2009 to 2018, we observed a significant increase in the annual prevalence of having a healthcare claim for vision-threatening diabetes-related eye disease among commercially insured adults aged 18–64 years with diabetes,” wrote investigators. “We also documented important differences in disease prevalence by sex, with men having a higher prevalence, and marked changes over this decade in the use of different treatment modalities, with anti-VEGF surpassing laser photocoagulation as the most-used treatment for [diabetic macular edema/vision-threatening diabetic retinopathy].”

With DME and diabetic retinopathy representing the most common causes of blindness among people with diabetes and the burden of diabetes expected to increase, a greater understanding of trends in prevalence of these comorbidities could help improve management and alleviate the burden of blindness. With this in mind, a team from the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention designed the current study with the intent of evaluating 10-year trends in prevalence and treatment of both these disease in a cohort of adults with diabetes younger than 65 years of age.

To do so, investigators designed their study as an analysis of healthcare claims for adults aged 18-64 years using the IBM MarketScan Database. For the purpose of analysis, investigators limited their analyses to patients continuously enrolled in commercial fee-for-service health insurance for 24 months with an ICD-9/ 10-CM code on 1 or more inpatient or 2 or more different-day outpatient claims in the index year or previous calendar year. Investigators used diagnostic and procedural codes to estimate annual prevalence of any DME, either DME or vision-threatening diabetic retinopathy, and anti-VEGF or laser photocoagulation therapy. Investigators noted these analyses were stratified by any DME, vision-threatening diabetic retinopathy with DME, and vision-threatening diabetic retinopathy without DME. The primary endpoint of interest for the investigators’ analyses was the average annual percent change (AAPC).

Upon analysis, results indicated the annual prevalence of people with diabetes who had DME or vision-threatening diabetic retinopathy increased significantly from 2.07% (95% CI, 2.05-2.10) in 2009 to 3.38% (95% CI, 3.33-3.42) in 2018 (AAPC, 7.5%; P <.001), with prevalence significantly higher among men compared with women from 2010 to 2018 (P <.01). In a similar fashion, the annual prevalence of people with diabetes who had any DME increased significantly from 0.67% (95% CI, 0.65-0.68) in 2009 to 2.60% (95% CI, 2.57-2.64) in 2018 (AAPC, 19.8%; P <.001), with the prevalence of any DME was significantly higher among men compared with women (P <.01).

In contrast, the annual prevalence of non-vision-threatening diabetes-related eye disease among people with diabetes decreased significantly from 8.93% (95%CI, 8.88-8.99) in 2009 to 5.9% (95% CI, 5.91-6.01) in 2018 (AAPC, -4.95%; P <.001). However, similar to other eye diseases examined, the prevalence of non-vision-threatening-diabetes-related eye disease was significantly higher among men compared with women (P <.001).

When assessing changes in trends of therapy use, results suggested the number of annual claims for anti-VEGF injections increased among patients with any DME (327%) as well as among those with vision-threatening diabetic retinopathy with DME (206%). Investigators also found the number of annuals claims for laser photocoagulation decreased among patients with any DME (-68%), vision-threatening diabetic retinopathy with DME (-54%), and vision-threatening diabetic retinopathy without DME (-62%).

“Future research could explore causes of the observed differences in eye disease by sex, as well as the barriers to eye care and treatment, to inform prevention interventions,” investigators added.

This study, “Trends in the Prevalence and Treatment of Diabetic Macular Edema and Vision-Threatening Diabetic Retinopathy Among Commercially Insured Adults Aged <65 Years,” was published in Diabetes Care.