Clustering and Treatment Patterns in Neovascular Age-related Macular Degeneration and Diabetic Macular Edema: US Claims Database Study

This study evaluated ophthalmic health care utilization patterns among United States patients with neovascular age-related macular degeneration (nAMD) or diabetic macular edema (DME) using Medicare, Medicaid, and commercial health care claims from July 1, 2016, to July 31, 2020. Patients aged ≥ 50 years for nAMD or ≥ 18 years for DME with ≥ 1 diagnosis record and ≥ 1 anti-VEGF intravitreal injection, and continuous enrollment in medical and pharmacy plans for ≥ 6 months before and ≥ 24 months after the first injection were included. Descriptive summaries and unsupervised machine-learning cluster analysis were conducted based on treatment frequency, intervals, monitoring visits, and corticosteroid use (DME only). Three clusters for nAMD and DME were identified, representing varying treatment intensities from high to low. The differing cluster characteristics suggest that socioeconomic status, comorbidities, and insurance type may be related to treatment utilization and highlight potential real-world disparities in ophthalmic health care.