John A. Hovanesian, MD, FACS, focuses his blog on real-world comanagement cases with valuable take-home messages. Dr. Hovanesian is a specialist in cornea, external ocular disease and refractive and cataract surgery with Harvard Eye Associates in Laguna Hills, Calif., a clinical instructor at UCLA Jules Stein Eye Institute and a member of the Primary Care Optometry News Editorial Board.

BLOG: Cost burden of diabetic retinopathy treatment is about to explode

The Protocol T study from the Diabetic Retinopathy Clinical Research Network was funded by the NIH as a long-term evaluation to answer the question of whether Lucentis, Eylea or Avastin is superior for treating various forms of retinopathy.

The data released at this writing suggest a strong advantage of Regeneron’s Eylea over Genentech’s Lucentis, the blockbuster drug first approved for exudative macular degeneration. Both drugs, however, were found to be effective in treating not only diabetic macular edema but also background diabetic retinopathy, causing regression of clinical signs of this once-untreatable early disease stage.

It’s exciting to see the emerging clarity of best practices for treating these conditions. At the same time, the future cost burden of these medications, which is thousands of dollars per dose, is daunting.

According to the American Diabetes Association, in 2012, 29.1 million Americans, or 9.3% of the total population, had diabetes. Interestingly, almost one-third of those are yet undiagnosed. Furthermore, there are 1.9 million new cases of diabetes diagnosed in the U.S. each year, and that rate seems to be growing. When you consider that diabetic retinopathy is found in roughly one-quarter of these diabetic patients, the magnitude of treatment cost becomes clear.

This disease makes the cost of treating macular degeneration look like pocket change. One retina specialist colleague of mine referred to these new data as heralding the “blowout of Medicare” — a sure sign that the current health care system cannot keep up with the growing cost of an increasingly sick population.

Surely it will be interesting and challenging to see how the health care system manages this growing cost in the years ahead. Certainly, doctors, patients, health insurance plans and the government are going to have to make some tough choices.

Disclosure: Hovanesian reports no relevant financial disclosures.