Medicare expenditures associated with diabetes and diabetic retinopathy

To estimate the expenditures for diabetic retinopathy in the United States by Medicare.

Retrospective data analysis using the 1997 through 2004 5% Medicare claims data. A case control design was used; eligible beneficiaries were 65 or older and without major ophthalmic conditions (cataract, cataract surgery, and macular degeneration) during the study period. Controls had diabetes but no evidence of diabetic retinopathy. There were two diabetic retinopathy case groups: beneficiaries with nonproliferative diabetic retinopathy (NPDR) and beneficiaries with proliferative diabetic retinopathy (PDR). Analyses quantified annual Medicare payments for case and control groups.

A total of 178,383 controls, 33,735 NPDR cases, and 6,138 PDR cases were identified. After adjusting for age, sex, and race, annual average Medicare payments for all care were significantly higher for case groups compared to the control group, as were average payments for ophthalmic care only (all P < 0.0001). In addition, average payments for all care and for ophthalmic care were substantially higher for PDR cases compared to NPDR cases.

These findings demonstrate substantial expenditures associated with diabetic retinopathy, and with PDR in particular, only part of which is due to ophthalmic care. Delaying progression may be associated with decreased Medicare expenditures.