Prescription Ratio and Costs of Intravitreal Injections for Diabetic Macular Oedema From 2015 to 2022

OBJECTIVES: Intravitreal drug injection (IVOM) is an established therapeutic option for the treatment of diabetic macular oedema (DME). However, up to 40% treatment non-adherence has been reported in first-line therapy with anti-VEGF. Steroids such as the longer-acting fluocinolone acetonide implant (FAc) and the shorter-acting dexamethasone implant are approved as second-line therapies. The aim of this evaluation is to analyse the prescription ratio of IVOM in the last eight years (2015-2022) and its costs.

METHODS: The prescription numbers from 2015 to 2022 are based on data from the PharMaAnalyst of the Scientific Institute of the AOK. Data from a cost-effectiveness model over a period of three years was used to illustrate the costs.

RESULTS: From 2015 to 2022, prescriptions for all IVOMs doubled. The proportion of steroids within IVOM increased threefold in the same period. IVOM therapy with anti-VEGF was associated with average SHI expenditure of €5,811.42 per patient in 2022. The costs for second-line therapy with steroids in the same year averaged €4,599.66 per patient. With 212,418 patients on anti-VEGF therapy and 18,168 patients on steroid therapy, total SHI expenditure in 2022 was around €1.3 billion. This corresponds to around 8% of total expenditure in the field of ophthalmology.

CONCLUSIONS: In the period from 2015 to 2022, there was an increase in second-line therapies. In addition, a reduction in the number of ophthalmologists can be observed. Due to the age structure of ophthalmologists and demographic change, it can be assumed that in future more patients need to be treated by less ophthalmologists. For this reason, sustainable and resource-saving IVOM therapy with long-lasting effectiveness could become more in focus in future.