Cost of Diabetic Macular Edema and Neovascular Age-Related Macular Degeneration in Serbia

OBJECTIVES: To estimate the total, direct and indirect costs of diabetic macular edema (DME) and neovascular age-related macular degeneration (nAMD) among treated patients at the Clinic for Eye Diseases (tertiary-care) of the University Clinical Centre of Serbia (UCCS).

METHODS: This observational retrospective study was conducted by two independent reviewers who checked records of medically treated DME and nAMD patients admitted to UCCS using an earlier developed and validated questionnaire. The collected data enabled the estimation of 22 variable categories of costs of DME and nAMD, including the costs of examinations, diagnostics, therapies, non-medical treatments (direct), the costs of early retirement, informal caregiver absenteeism (indirect). Items’ prices were cited from the official sources and expressed in 2023 Serbian dinars (RSD).

RESULTS: Data were collected for 100 DME and 40 nAMD patients. Annual costs of an average DME patient at the clinic amounted RSD 1,059,900 (95% confidence interval (95% CI): 893,580-1,226,220), of which 55% were direct costs dominated by the anti-VEGF therapy cost, and 45% were indirect costs consisting of early retirement, informal caregiver absenteeism and patient’s presentism. The average nAMD patient had annual costs of RSD 602,931 (95%CI: 487,592-718,270), of which 74% were direct costs mainly related to anti-VEGF therapy, and 26% were indirect, referring mostly to informal caregiver absenteeism.

CONCLUSIONS: Presented study was among first to estimate DME and nAMD costs for patients treated at a tertiary ophthalmology clinic in Serbia. It appeared that almost half of total DME and one fourth of total nAMD costs were indirect, potentially neglected by the health-care payer. Accounting for a very low access to anti-VEGF therapy in primary- and secondary-care, and assuming the same distribution of non-medical costs among those as in tertiary clinic, it could be estimated that DME and nAMD in Serbia costs RSD 21 billion, and RSD 15 billion, respectively.