Patterns and costs associated with progression of age-related macular degeneration.

PURPOSE: To evaluate patterns of disease progression among individuals with age-related macular degeneration (AMD) and to compare costs over time. DESIGN: Retrospective data analysis using 5% Medicare claims data from 1997 through 2009. METHODS: Beneficiaries were included if they had no diagnosis of AMD in 1997, were 65 years of age or older, had data through 2009, and had no major ophthalmic conditions. Two cohorts were identified: those who had dry AMD in 1998 (cases) and matched controls who never had AMD. RESULTS: There were 52,607 beneficiaries who never had AMD and 1184 who were diagnosed with dry AMD in 1998. Among beneficiaries with dry AMD, the disease progressed in 20.4% to the wet form by 2009. From 1999 to 2009, average annual Medicare expenditures increased from $11,265 to $24,494 (cases whose disease did not progress) and from $11,712 to $34,308 (cases whose disease progressed). Among beneficiaries without AMD, expenditures also increased over time (from $4736 in 1999 to $17,473 in 2009), but consistently were lower than cases' expenditures. Considering ophthalmic expenditures, the pattern was more pronounced: beneficiaries without AMD had annual expenditures less than $100, those with dry AMD had expenditures at least 3 times more, and wet AMD beneficiaries' costs were at least 5-fold more than that of those with dry disease. A subgroup analysis of beneficiaries without hypertension revealed similar patterns, although expenditures were lower than in the general population. CONCLUSIONS: AMD progression seems to be associated with increased annual Medicare expenditures. Findings suggest that halting or slowing disease progression using proven treatment such as Age-Related Eye Disease Study-endorsed vitamins or novel technologies could have a substantial positive impact by lowering public health expenditures.