Quantifying the direct costs of diabetic retinopathy in a mixed healthcare system: a hospital-based study from governmental and patient perspectives.

backgroundAdvanced diabetic retinopathy (DR), including proliferative DR and diabetic macular edema (DME), demands costly interventions like anti-VEGF therapy, laser treatment, and vitrectomy. Despite global data on its economic burden, cost-of-illness studies in Iraq—particularly those covering public spending, out-of-pocket costs, and non-medical expenses—are limited.

objectiveTo evaluate the direct medical and non-medical cost of illness associated with diabetic retinopathy (DR) in Iraq from the Ministry of Health (MOH) and patient perspectives.

methodsA cost-of-illness analysis using the bottom-up method of micro-costing was conducted at large Teaching Eye Hospital in Baghdad, Iraq. Data was collected retrospectively between October 2024 and March 2025. Direct medical costs were assessed from the MOH perspective, while direct medical and direct non-medical costs were analyzed from patient perspectives. Data was obtained from patient interviews, hospital records, and national medicine procurement databases. From the MOH perspective, direct medical costs include anti-VEGF injections, healthcare practitioner labor, hospital operations and supplies, examination equipment, laser therapy, and vitrectomy procedures. Statistical comparisons between disease stages were performed using ANOVA and a Tukey post-hoc test.

resultsThe study included 603 patients with 994 eyes affected by DR. From the Ministry of Health (MOH) perspective, total annual treatment costs reached 790,043,475 IQD (US$678,393.70), averaging 2,920,896 IQD (US$2,212.80) per eye annually and 300,894 IQD (US$227.95) per visit. Anti-VEGF therapy (bevacizumab, aflibercept) accounted for 82.36% of the total cost. In comparison, direct medical costs from patient perspective were mainly attributed to private treatments and anti-VEGF injections, accounting for 36.94% of patient expenditures (US$ 96,598.48). Non-medical expenses—mainly transportation and accommodation—constituted the largest financial burden for patients, accounting for 58.37% of total costs (US$161,109.84), with annual per-eye costs averaging 213,945.6 IQD (US$162.08). Managing DME imposed significantly higher financial burden than other DR stages.

conclusionThis study highlights the considerable financial burden of DR management, particularly in advanced disease stages that necessitate intravitreal anti-VEGF therapy. The Iraqi government spends approximately six times more on direct medical costs for treating DR in public hospitals than individual patients do out of pocket. It emphasizes the need for health policy interventions, improved access to cost-effective therapies, and caregiver support programs to reduce the financial impact on affected individuals and families.