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Healthcare resource use and costs of diabetic macular oedema for patients with antivascular endothelial growth factor versus a dexamethasone intravitreal implant in Korea: a population-based study
  1. HyunJeong Cho1,
  2. Kyung Seek Choi2,
  3. Joo Yong Lee3,
  4. Donghwan Lee4,
  5. Nam-Kyong Choi5,
  6. YouKyung Lee6,
  7. SeungJin Bae1
  1. 1 College of Pharmacy, Ewha Womans University, Seoul, The Republic of Korea
  2. 2 Department of Ophthalmology, Soonchunhyang University Hospital Seoul, Yongsan-gu, The Republic of Korea
  3. 3 Department of Ophthalmology, Asan Medical Center, Songpa-gu, The Republic of Korea
  4. 4 Department of Statistics, Ewha Womans University, Seoul, The Republic of Korea
  5. 5 Department of Health Convergence, Ewha Womans University, Seoul, The Republic of Korea
  6. 6 Allergan Korea Ltd, Seocho-gu, The Republic of Korea
  1. Correspondence to Dr SeungJin Bae; sjbae{at}


Objectives To estimate the costs and healthcare resources of patients with diabetic macular oedema (DME) who received intravitreal antivascular endothelial growth factor (anti-VEGF) agents or a dexamethasone intravitreal implant (DEX-implant) in Korea.

Design Retrospective cohort study.

Setting The Korean National Health Insurance claim data from 1 January 2015 to 30 June 2017 were retrieved from the Health Insurance Review and Assessment Service.

Participants Adult patients with DME who were diagnosed with diabetic retinopathy or DME and received ranibizumab, aflibercept or a DEX-implant in conjunction with intravitreal injection were included. Patients whose primary diagnoses were age-related macular degeneration or retinal vein occlusion were excluded.

Main outcome measures Healthcare resource utilisation and costs related to DME in the 12-month postindex period.

Results During the study period, 182 patients and 414 patients were identified in the anti-VEGF and DEX-implant groups, respectively, and there was no significant difference in the demographic characteristics between the two groups. The outpatient eye care-related medical costs were US$3002.33 for the anti-VEGF group vs US$2250.35 for the DEX-implant group (p<0.0001). After adjusting the relevant covariates based on the generalised linear model, the estimated outpatient eye care-related medical costs were 33% higher in the anti-VEGF group than in the DEX-implant group (p<0.0001, 95% CI 22% to 45%). The utilisation pattern of the two groups showed no significant difference except for the number of intravitreal injections, which was higher in the anti-VEGF group (2.69±2.29) than in the DEX-implant group (2.09±1.37, p<0.001).

Conclusion The average annual eye-related medical cost of the DEX-implant group was significantly lower than that of the anti-VEGF group during the study period, which was mainly due to decreased utilisation of eye care-related injections. Further long-term studies are needed.

  • diabetic macular edema
  • population-based study
  • resource utilization
  • cost of illness
  • Korea
  • agencies regulation

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  • Contributors HC conducted the statistical analysis and interpretation and drafted the article. HC and SB conceived the study and designed the analysis. KSC, JYL and YL defined the DME cohort and provided clinical advice on the design of the study. N-KC and DL supervised the statistical analysis of the data. All of the authors approved the final version of the article.

  • Funding This study was financially supported by Allergan Korea.

  • Competing interests The funding body has not been involved with the study design or the conduct of the study. YL was employed by Allergan Korea, but her input was based on her personal opinions.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.

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