OBJECTIVES : Diabetic macular edema (DME) is the leading cause of vision loss in people with diabetes and preserve the vision of more than one million Portuguese with diabetes is a major challenge. This study aimed to analyze the number of patients with DME treated with anti-VEGF drugs in the Portuguese national health service (NHS) and assess regional differences.

METHODS : This administrative database study used the universe of inpatient and day cases stays of NHS hospitals in Portugal between 2013-2018. Cases were selected based on surgical codes (ICD-9-CM and ICD-10) for intravitreal procedures and were used as proxies for intravitreal anti-VEGF injections. Patients were classified with DME if they had a principal or secondary diagnosis of DME and 18 years old or above. Anti-VEGF treatment rate was calculated for each municipality: (number of episodes per year / annual average resident population per year) X 100,000.

RESULTS : From 2013 to 2018, 19,859 patients with DME were treated with intravitreal anti-VEGF in the Portuguese NHS. Annual number of DME patients treated increased from 2,812 in 2013 to 7,121 in 2018, corresponding to a mean annual increase of 28%. DME treated patients were mostly between 60-79 years-old with a slightly higher proportion of women (50-51%). In 2018, most patients (47.5%) were treated at North region and metropolitan area of Oporto, followed by metropolitan area of Lisbon (21.7%). Remaining treated patients were distributed by the Central region (16%), Alentejo (11%) and Algarve (4%). Treatment rates per municipality ranged from 69 (first quartile) to 182 (third quartile) episodes per 100,000 inhabitants.

CONCLUSIONS : The number of DME patients treated with intravitreal anti-VEGF drugs has been growing at a national level, however striking regional discrepancies were observed which suggests a heterogeneous level of access to the treatment. Factors associated with anti-VEGF treatment rates should be investigated to overcome possible regional access barriers.