Clinical and economic impact of broader implementation of optical coherence tomography and anti-VEGF therapy for diabetic retinopathy and macular edema in type 1 diabetes

Objective. To assess clinical and economic consequences of broader implementation of optical coherence tomography (OCT) and anti-vascular endothelial growth factor (anti-VEGF) therapy for patients with type 1 diabetes mellitus (DM1) presenting with diabetic retinopathy (DR) and diabetic macular edema (DME). Material and methods. The authors used original Markov model to determine the need for OCT and anti-VEGF therapy. Analysis evaluated clinical and economic implications from the state perspective associated with broader implementation of anti-VEGF treatment in accordance with clinical guidelines for adults with DM1 and progressing DR and DME. Results. Additional cost of OCT for obligatory medical insurance system was estimated at 24.3 million RUB in the first year and 432 million RUB over 5 years. Necessary funding for anti-VEGF therapy in population with DR and DME was estimated as 2.99 billion RUB for the first year, 9.73 billion RUB throughout 3 years and 17.46 billion RUB throughout 5 years. The modeled scenario entails additional costs (direct and indirect) across all stages from diagnosis to treatment: RUB 368 million in the first year and RUB 1.245 million over 5 years. Broader implementation of OCT and anti-VEGF therapy in DM1 patients will be valuable to overcome under-detection of DR and DME during screening and reduce the number of years with group II disability to 23.6% and group III disability to 53.3% compared to current practice. Conclusion. Additional need for OCT and necessary funding were identified for patients with type 1 diabetes mellitus and suspected diabetic retinopathy and diabetic macular edema. OCT and anti-VEGF therapy in accordance with clinical guidelines are associated with additional costs, but will reduce the rate of vision-related disability in patients with type 1 diabetes mellitus.