The Economic Burden of Diabetic Retinopathy in Jordan: Cost Analysis and Associated Factors

Figures & data

Table 1 General Demographics and Characteristics

Variables	Number*	Percentage (%)
	Mean ± SEM
Sex
Male	125	54.6
Female	104	45.4
Age (years)	60.1 ± 0.6
Type of DM treatment
OHGA	115	50.2
Insulin-based regimen	114	49.8
Duration of DM (years)	12.4 ± 0.6
HbA1c (%)	8.5 ± 0.2
Diabetic nephropathy	17	8.2
Lower limb ischemia	8	3.8
Method of presentation
Screening	82	35.8
Decrease of vision	78	34.1
Referral case	12	5.2
Others	57	24.9
Mean number of intravitreal anti-VEGF injections:
Right eye	2.39 ± 0.3
Left eye	2.18 ± 0.3
Total both eyes	4.57 ± 0.5
The mean number of laser sessions
Right eye	0.71 ± 0.1
Left eye	0.64 ± 0.09
Total both eyes	1.35 ± 0.2
Surgical operation of the right eye:
No operation	138	60.3
Minor operations	65	28.4
Major operations	26	11.4
Surgical operation of the left eye:
No operation	152	66.4
Minor operations	53	23.1
Major operations	24	10.5
Glaucoma:
No glaucoma	195	85.2
One eye	8	3.5
Both eyes	26	11.4
Duration of FU (months)	37.3 ± 1.7
Number of FU visits	8.83 ± 0.5
Total cost	1233.90 ± 103.1

Note: *Number= 229.

Abbreviations: SEM, standard error of the mean; DM, diabetes mellitus; OHGA, oral hypoglycemic agents; VEGF, vascular endothelial growth factor; FU, follow up.

Table 2 Visual and Clinical Outcome

Variables	Number*	Percentage (%)
	Mean ± SEM
DME at presentation
No DME	181	79.0
One eye	16	7.0
Both eyes	32	14.0
DME at six months
No DME	139	75.5
One eye	16	8.7
Both eyes	28	15.2
DME at the last follow-up visit
No DME	183	82.8
One eye	20	9.1
Both eyes	18	8.1
Worst stage of DR at presentation
No DR	114	49.7
NPDR	56	24.5
Low-risk PDR	32	14.0
Advanced PDR	27	11.8
Worst stage of DR at six months
No DR	83	43.5
NPDR	51	26.7
Low-risk PDR	42	22.0
Advanced PDR	15	7.0
Worst stage of DR at last FU visit
No DR	99	43.2
NPDR	59	25.8
Low-risk PDR	52	22.7
Advanced PDR	19	8.3
Mean BCVA (LogMAR)
At presentation	0.5022 ± 0.04
At six months	0.4883 ± 0.04
At the last FU visit	0.4923 ± 0.05

Note: *Number: 229.

Abbreviations: SEM, standard error of the mean; DME, diabetic macular edema; DR, diabetic retinopathy; NPDR, non-proliferative diabetic retinopathy; PDR, proliferative diabetic retinopathy; FU, follow up; BCVA, best corrected visual acuity.

Table 3 Factors Affecting Total Direct Medical DR-Related Cost

Variables	Mean ± SEM* or B Regression Coefficient ± SEM**
	Total Salary (JOD)	P value
Sex*
Male	1133.2 ± 136.1	NS
Female	1354.9 ± 156.2
Age (years)**	3.44 ± 0.1	NS
Type of DM treatment*
OHGA	840.4 ± 116.5	0.0001
Insulin-based regimen	1611.6 ± 169.3
Duration of DM (years)**	69.1 ± 10.2	0.001
HbA1c (%)**	239.1 ± 41.1	0.0001
Diabetic nephropathy*	2230.7 ± 441.1	0.009
Lower limb ischemia*	1603.5 ± 321.7	NS
Method of presentation*
Screening	575.1 ± 89.1	0.0001
Decrease of vision	1437.4 ± 112.3
Referral case	3487.5 ± 130.5
Others	1413.2 ± 113.6
Mean number of intravitreal anti-VEGF injections**	138.1 ± 78.2	0.001
The mean number of laser sessions**	301.9 ± 45.1	0.001
Surgical operation of the right eye*
No operation	665.8 ± 190.1	0.001
Minor operations	1595.2 ± 312.3
Major operations	3345.8 ± 365.6
Surgical operation of the left eye*
No operation	786.4 ± 67.1	0.001
Minor operations	1471.6 ± 114.6
Major operations	3657.6 ± 567.1
Glaucoma*
No glaucoma	1032.3 ± 81.2	0.001
One eye	2111.9 ± 256.4
Both eyes	2476.1 ± 315.7
Duration of FU (months)**	14.6 ± 9.1	0.001
Number of FU visits**	130.6 ± 89.1	0.001
Presence of DME at presentation*
No DME	871.9 ± 64.1	0.0001
One eye	2339.9 ± 157.3
Both eyes	2728.3 ± 162.6
Worst stage of DR at presentation*
No DR	497.6 ± 30.2	0.00001
NPDR	1440.6 ± 180.1
Low-risk PDR	2014.2 ± 197.1
Advanced PDR	2991.9 ± 202.1
Mean BCVA at presentation (LogMAR)**	813.6 ± 183.1	0.001

Notes: *The statistical test used is ANOVA test and data presented in Mean with SEM. **The statistical test used is linear logistic regression test and data presented with B coefficient with SEM.

Abbreviations: SEM, standard error of the mean; DM, diabetes mellitus; OHGA, oral hypoglycemic agents; VEGF, vascular endothelial growth factor; DME, diabetic macular edema; DR, diabetic retinopathy; NPDR, non-proliferative diabetic retinopathy; PDR, proliferative diabetic retinopathy; FU, follow up; BCVA, best corrected visual acuity.

Table 4 Factors Affecting the BCVA at the Last Follow-Up Visit

Variables	Mean ± SEM* or B Regression Coefficient ± SEM**
	BCVA at Last Follow-Up (LogMAR)	P value
Sex*
Male	0.4657 ± 0.05	NS
Female	0.5260 ± 0.03
Age (years)**	0.006 ± 0.004	NS
Type of DM treatment*
OHGA	0.2929 ± 0.03	0.01
Insulin-based regimen	0.6509 ± 0.06
Duration of DM (years)**	0.028 ± 0.005	0.001
HbA1c (%)**	0.105 ± 0.02	0.001
Diabetic nephropathy*	0.9328 ± 0.03	0.001
Lower limb ischemia*	0.800 ± 0.01	NS
Method of presentation*
Screening	0.2234 ± 0.04	0.001
Decrease of vision	0.5579 ± 0.05
Referral case	1.3500 ± 0.09
Others	0.5804 ± 0.06
Mean number of intravitreal anti-VEGF injections**	0.031 ± 0.004	0.01
The mean number of laser sessions**	0.072 ± 0.002	0.01
Surgical operation of the right eye*
No operation	0.3927 ± 0.05	0.001
Minor operations	0.4318 ± 0.08
Major operations	1.1462 ± 0.1
Surgical operation of the left eye*
No operation	0.4425 ± 0.04	0.001
Minor operations	0.3135 ± 0.05
Major operations	1.1833 ± 0.09
Glaucoma*
No glaucoma	0.3633 ± 0.03	0.001
One eye	1.2255 ± 0.07
Both eyes	1.200 ± 0.08
Duration of FU (months)**	0.001 ± 0.002	NS
Number of FU visits**	0.022 ± 0.004	0.01
Presence of DME at presentation*
No DME	0.3529 ± 0.05	0.001
One eye	0.8875 ± 0.8
Both eyes	1.0531 ± 0.1
Worst stage of DR at presentation*
No DR	0.1693 ± 0.01	0.0001
NPDR	0.4838 ± 0.04
Low-risk PDR	0.9403 ± 0.07
Advanced PDR	1.1722 ± 0.2

Notes: *The statistical test used is ANOVA test and data presented in Mean with SEM. **The statistical test used is linear logistic regression test and data presented with B coefficient with SEM.

Abbreviations: SEM, standard error of the mean; DM, diabetes mellitus; OHGA, oral hypoglycemic agents; VEGF, vascular endothelial growth factor; DME, diabetic macular edema; DR, diabetic retinopathy; NPDR, non-proliferative diabetic retinopathy; PDR, proliferative diabetic retinopathy; FU, follow up; BCVA, best corrected visual acuity.