Burden Of Treatment Among Patients Undergoing Intravitreal Injections For Diabetic Macular Oedema In Australia

Abstract

Aim

The incidence and prevalence of diabetes mellitus (DM) in Australia is increasing. Thus, it is essential that practitioners appreciate the impending effect that increasing incidence of diabetes has on patients and the wider community. Accordingly, this study examines the humanistic burden of intravitreal injections for the treatment of diabetic macular oedema (DMO) among several health variables.

Methods

Survey data from a representative sample of Australian adults undergoing treatment for DMO were examined. Respondents participated via an online survey recruited by means of a national online consumer panel and the New South Wales and Victorian Diabetes Foundations. The online survey included questions relating to the humanistic burden of disease, such as the emotional and physical impact of intravitreal injection therapy; the practical impacts of injection therapy; and to identify potential improvements to treatment regimens.

Results

Sixty-five participants took part in the online survey. Of these, 49% had their most recent injection <1 month prior to completing the survey. The mean age was 52.5 years, with the majority of patients in full-time work. A substantial proportion of participants had several comorbidities, with a significantly high Charlson comorbidity index of 2.7. Participants reported the main burden of DMO care was the direct cost of medical treatment and the time burden demanded upon their carers. Results suggest that the overall burden is significant for those with diabetes and increases as additional complications of diabetes occur.

Conclusion

These results suggest that treatment strategies for DMO should consider clinical, humanistic and economic burden and patients should be educated on the roles of complications in disease outcomes. Less frequent treatment regimens could also reduce the economic burden and assist in decreasing the effect on health care resources, relevant to the escalation in the prevalence of diabetes.

Keywords:

• diabetes
• macular oedema
• intravitreal injections
• anti-VEGF
• quality of life
• patient perspective

Acknowledgments

The authors would like to acknowledge and thank, Jodi Tainton from Allergan, Australia, for her help in initiating the project.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. Ethics approval was granted from Bellberry Limited, Australia, on 14 November 2018. Application number: 2018-09-745.

Author contributions

G.G. and S.K. developed the methods, conducted the study, extracted data and performed the analyses and revised the manuscript. K.S. wrote the draft manuscript and performed additional analyses, additional data extraction and interpretation of data. T.H. reviewed and edited the analyses and interpretation of data and revised and edited the manuscript. A.C. conceived the idea, edited and revised the manuscript, supervised the findings of this work and oversaw responsibility of the data. All authors discussed the results and contributed to and approved the final manuscript. All authors agree to be accountable for all aspects of the work ensuring that questions relating to the accuracy or integrity of all the work are appropriately investigated and resolved.

Disclosure

Andrew A Chang has acted as a consultant for Novartis, Bayer and Alcon. Gerry Guinan and Saskia Koller are employees of So What Research, Australia Pty Ltd. Gerry Guinan reports personal fees from Allergan Australia Pty Ltd, during the conduct of the study; personal fees from Allergan Australia Pty Ltd, outside the submitted work; Saskia Koller reports personal fees from Allergan, during the conduct of the study. The authors report no other conflicts of interest in this work.

Additional information

Funding

Financial support for ethics approval was supported through a grant from Allergan Australia.