The economic burden of diabetic retinopathy care at a tertiary eye care center in South India

Purpose: The aim of this study was to analyze the cost and factors affecting diabetic retinopathy (DR) care in a tertiary eye care facility in South India. Methods: In a retrospective, observational study, we evaluated the costs incurred in DR management in each stage of retinopathy from electronic medical records. Both medical and indirect costs (transportation and boarding) were calculated. Results: The study evaluated 1000 consecutive patients (2000 eyes) with DR, from January to June 2019. One-third (32%; n = 321) patients were females. The median cost per patient was INR 8,214 (IQR 2,812-29,748). Cost of care was higher in patients with sight-threatening DR (STDR) compared to non-STDR (INR 31,820 vs INR 14,356, P < 0.001). Among 57.3% (n = 573;1137 eyes) of subjects who completed treatment, there was a statistically significant reduction in visual impairment (427 to 355 eyes) and blindness (<3/60) (132 to 103 eyes) from baseline (P < 0.001). The number of follow-up visits had a negative association with travel distance and socioeconomic status (P < 0.001); the positive association was seen with DR severity (P = 0.002) and total cost (P < 0.001) on regression analysis. There was a nearly 3-fold difference in the average medical cost per eye for subjects with severe visual loss (<3/60) (INR 26,270) compared to those with good vision (≥6/12) (INR 8,510). Conclusion: Treatment of DR benefits, but the cost of care increases with disease severity and visual impairment. Compliance to care was related to DR severity and treatment cost. Some of the barriers could be reduced with greater advocacy and reduced travel distance.