The impact of financial affordability on patient adherence to the dosing schedule of Anti-Vascular Endothelial Growth Factor in managing Diabetic Macular Edema

Purpose: Regular maintenance dosing of Intravitreal anti-VEGF (anti-vascular endothelial growth factor) for Diabetic Macular edema (DME) poses a challenge for patients. We investigated whether financial affordability plays a role in influencing patients' adherence to the prescribed dosage schedule. Methods: In this prospective, interventional, comparative, cohort study of 12 months duration, naïve DME patients were enrolled in 3 groups. Group I: self-paying patients. Group II: patients with medical insurance. Group III: patients treated free of charge. The treatment regimen was 3 consecutive monthly injections followed by monthly visits and anti-VEGF injections as needed (pro re nata, PRN).Two indicators were measured. First, how many did not complete the loading dose phase and second, adherence to the PRN stage of the study over a period of 12 months. Results: 264 patients were enrolled. Group I: 112 patients, Group II: 90 and Group 3: 60 patients. 230 patients (87%) adhered to the initial 3 monthly injection and 162 (61.3%) patients of initial cohort adhered to prn stage of the study. In the loading dose phase best compliance was seen in Group I; in the PRN stage best compliance was seen in Group II. Overall, best compliance was seen in Group III where 63.3% patients adhered to the full schedule though it was not statistically significant (p = 0.93226). Conclusion: Patient adherence and success rates of anti-VEGF therapy may be increased by analyzing various factors affecting patient compliance and raising awareness about DME. In our study, financial affordability was not a major reason for non-compliance.