Please use this identifier to cite or link to this item: https://doi.org/10.1371/journal.pone.0180949
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dc.titleDirect medical cost associated with diabetic retinopathy severity in type 2 diabetes in Singapore
dc.contributor.authorZhang X.
dc.contributor.authorLow S.
dc.contributor.authorKumari N.
dc.contributor.authorWang J.
dc.contributor.authorAng K.
dc.contributor.authorYeo D.
dc.contributor.authorYip C.C.
dc.contributor.authorTavintharan S.
dc.contributor.authorSum C.F.
dc.contributor.authorLim S.C.
dc.date.accessioned2019-11-01T07:51:20Z
dc.date.available2019-11-01T07:51:20Z
dc.date.issued2017
dc.identifier.citationZhang 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
dc.identifier.issn19326203
dc.identifier.urihttps://scholarbank.nus.edu.sg/handle/10635/161185
dc.description.abstractDiabetic 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.
dc.rightsAttribution 4.0 International
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.sourceUnpaywall 20191101
dc.subjectadult
dc.subjectaged
dc.subjectArticle
dc.subjectchronic kidney failure
dc.subjectcontrolled study
dc.subjectcost difference
dc.subjectcost of illness
dc.subjectdiabetic retinopathy
dc.subjectdigital color fundus photograph
dc.subjectdirect medical cost
dc.subjectdisease association
dc.subjectdisease classification
dc.subjectdisease severity
dc.subjectfemale
dc.subjecthospital management
dc.subjecthuman
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectmiddle aged
dc.subjectneuropathy
dc.subjectnon insulin dependent diabetes mellitus
dc.subjectnon proliferative diabetic retinopathy
dc.subjectphotography
dc.subjectproliferative diabetic retinopathy
dc.subjectprophylaxis
dc.subjectretinopathy
dc.subjectSingapore
dc.subjectsmoking
dc.subjectvery elderly
dc.subjectbody mass
dc.subjectdiabetic retinopathy
dc.subjectdisease course
dc.subjecteconomics
dc.subjectnon insulin dependent diabetes mellitus
dc.subjectpathology
dc.subjectyoung adult
dc.subjectAdult
dc.subjectAged
dc.subjectBody Mass Index
dc.subjectDiabetes Mellitus, Type 2
dc.subjectDiabetic Retinopathy
dc.subjectDisease Progression
dc.subjectFemale
dc.subjectHumans
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectRenal Insufficiency, Chronic
dc.subjectSingapore
dc.subjectYoung Adult
dc.typeArticle
dc.contributor.departmentOPHTHALMOLOGY
dc.description.doi10.1371/journal.pone.0180949
dc.description.sourcetitlePLoS ONE
dc.description.volume12
dc.description.issue7
dc.description.pagee0180949
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