OBJECTIVES: Diabetic Retinopathy (DR) is the most common microvascular complication of both Type-1 and Type-2 diabetes and is considered the leading cause of visual impairment in working-aged adults worldwide. There are two main stages of diabetic retinopathy: non-proliferative diabetic retinopathy (NPDR-mild to severe) and proliferative diabetic retinopathy (PDR-mild to severe). This study was conducted to identify and collate evidence on the economic burden of DR.

METHODS: A comprehensive targeted literature search was performed for studies published in English from database inception to January 2019 in Embase, MEDLINE, MEDLINE-In Process, and Cochrane library. Studies reporting on the economic burden in adult DR patients were included.

RESULTS: The review identified 21 studies. Patients with DR consume more healthcare resources such as visits to diabetic education/nutrition specialist (30.4% vs. 55.9%; no DR vs. severe NPDR/PDR during 2005-2006), dilated eye examination (62.2% vs. 93.8%; no DR vs. severe NPDR/PDR), hospitalisations (0% vs. 15.4%; mild NPDR vs. PDR without macular edema), and incur higher costs (total Medicare payments in 2006 USD: 9,981 vs. 13,806 for no DR vs. PDR) compared to diabetic patients without DR. As DR progresses, costs associated tend to increase and severe DR patients cost around 10 times more than mild NPDR patients. The overall healthcare costs incurred was USD 493 million in 2004 in the US and €9.9 million in 2008 in Sweden. Median direct costs for inpatient, outpatient and A&E services are significantly higher for patients with PDR than those without DR. From the societal perspective, the cost of medical devices and temporary work disability contribute towards 40-50% of the total costs.

CONCLUSIONS: These data suggests that the costs of DR contribute significantly towards total health care expenditure and increases with severity. As such, it is important to prevent progression of DR from mild to severe stages in order to limit the economic burden.