Please use this identifier to cite or link to this item: https://doi.org/10.1371/journal.pone.0180949
Title: Direct medical cost associated with diabetic retinopathy severity in type 2 diabetes in Singapore
Authors: Zhang X.
Low S.
Kumari N.
Wang J.
Ang K.
Yeo D.
Yip C.C. 
Tavintharan S.
Sum C.F.
Lim S.C.
Keywords: adult
aged
Article
chronic kidney failure
controlled study
cost difference
cost of illness
diabetic retinopathy
digital color fundus photograph
direct medical cost
disease association
disease classification
disease severity
female
hospital management
human
major clinical study
male
middle aged
neuropathy
non insulin dependent diabetes mellitus
non proliferative diabetic retinopathy
photography
proliferative diabetic retinopathy
prophylaxis
retinopathy
Singapore
smoking
very elderly
body mass
diabetic retinopathy
disease course
economics
non insulin dependent diabetes mellitus
pathology
young adult
Adult
Aged
Body Mass Index
Diabetes Mellitus, Type 2
Diabetic Retinopathy
Disease Progression
Female
Humans
Male
Middle Aged
Renal Insufficiency, Chronic
Singapore
Young Adult
Issue Date: 2017
Citation: Zhang X., Low S., Kumari N., Wang J., Ang K., Yeo D., Yip C.C., Tavintharan S., Sum C.F., Lim S.C. (2017). Direct medical cost associated with diabetic retinopathy severity in type 2 diabetes in Singapore. PLoS ONE 12 (7) : e0180949. ScholarBank@NUS Repository. https://doi.org/10.1371/journal.pone.0180949
Rights: Attribution 4.0 International
Abstract: Diabetic retinopathy (DR) is a leading cause of vision-loss globally among type 2 diabetes (T2DM) patients. Information on the economic burden of DR in Singapore is limited. We aim to identify the total annual direct medical costs of DR at different stages, and to examine factors influencing the costs. Four hundreds and seventy T2DM patients who attended the Diabetes Centre in a secondary hospital in Singapore in 2011–2014 were included. Digital color fundus photographs were assessed for DR in a masked fashion. Retinopathy severity was further categorized into non-proliferative DR (NPDR), including mild, moderate and severe NPDR, and proliferative DR (PDR). Medical costs were assessed using hospital administrative data. DR was diagnosed in 172 (39.5%) patients, including 51 mild, 62 moderate and 18 severe NPDR, and 41 PDR. The median cost in DR [2012.0 (1111.2–4192.3)] was significantly higher than that in non-DR patients [1158.1 (724.1–1838.9)] (p<0.001). The corresponding costs for mild, moderate, severe NPDR and PDR were [1167.1 (895.4–2012.0)], [2212.0 (1215.5–3825.5)], [2717.5 (1444.0–6310.7)], and [3594.8.1 (1978.4–8427.7)], respectively. After adjustment, the corresponding cost ratios for mild, moderate, severe NPDR, and PDR relative to non-DR were 1.1 (p = 0.827), 1.8 (p = 0.003), 2.0 (p = 0.031) and 2.3 (p<0.001), respectively. The other factors affecting the total cost include smoking (ratio = 1.7, p = 0.019), neuropathy (ratio = 1.9, p = 0.001) and chronic kidney disease (CKD) (ratio = 1.4, p = 0.019). The presence and severity of DR was associated with increased direct medical costs in T2DM. Our results suggest that preventing progression of DR may reduce the economic burden of DR. © 2017 Zhang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Source Title: PLoS ONE
URI: https://scholarbank.nus.edu.sg/handle/10635/161185
ISSN: 19326203
DOI: 10.1371/journal.pone.0180949
Rights: Attribution 4.0 International
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