Purpose: Little is known about the costs of cystoid macular edema (CME), an important complication associated with cataract surgery. The purpose of this analysis was to estimate the cost of treatment for CME in the United States.
Methods: Data were analyzed from the 1997 through 2001 Medicare 5% Beneficiary Encrypted Files. Beneficiaries who underwent cataract surgery were identified and stratified by diagnosis of CME (cases) or no diagnosis of CME (controls) within 1 year after surgery. Claims and reimbursements for ophthalmic care were identified. Subgroup analyses explored CME costs among beneficiaries with diabetes versus those without diabetes.
Results: Of 139,759 beneficiaries with cataract surgery, 1.95% (2,720) were diagnosed with CME. Annual total ophthalmic claims were 41% ($3,298) higher for cases than for controls; payments were 47% ($1,092) higher (both P < 0.0001). Approximately 16% (23,122) of cataract patients had diabetes. The rate of CME diagnosis was significantly higher for diabetics than for nondiabetics (3.05% vs. 1.73%, respectively). Differences in claims and payments between cases and controls were similar for diabetic and nondiabetic subgroups.
Conclusion: CME is associated with substantial costs. Therapies that prevent or decrease CME severity are likely to result in cost savings, particularly among diabetic beneficiaries. Further analyses should explore the relationship of comorbidities to costs among CME patients.