Prevalence and healthcare costs of diabetic retinopathy: a population-based register study in Sweden
Open accessAbstract
Aims/hypothesis The aim of the present study was to estimate the prevalence and healthcare costs of diabetic retinopathy (DR).Methods This population-based study included all residents (n = 251,386) in the catchment area of the eye clinic of Linköping University Hospital, Sweden. Among patients with diabetes (n = 12,026), those with and without DR were identified through register data from both the Care Data Warehouse in Ostergötland, an administrative healthcare register, and the Swedish National Diabetes Register. Healthcare cost data were elicited by record linkage of these two registers to data for the year 2008 in the Cost Per Patient Database developed by Ostergötland County Council.Results The prevalence of any DR was 41.8% (95% CI 38.9-44.6) for patients with type 1 diabetes and 27.9% (27.1-28.7) for patients with type 2 diabetes. Sight-threatening DR was present in 12.1% (10.2-14.0) and 5.0% (4.6-5.4) of the type 1 and type 2 diabetes populations respectively. The annual average healthcare cost of any DR was euro72 (euro53-91). Stratified into background retinopathy, proliferative DR, maculopathy, and the last two conditions combined, the costs were euro26 (euro10-42), euro257 (euro155-359), euro216 (euro113-318) and euro433 (euro232-635) respectively. The annual cost for DR was euro106,000 per 100,000 inhabitants.Conclusions This study presents new information on the prevalence and costs of DR. Approximately one-third of patients with diabetes have some form of DR. Average healthcare costs increase considerably with the severity of DR, which suggests that preventing progression of DR may lower healthcare costs.
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Eight studies did not distinguish between costs of different conditions.
“Of note, eight studies [47–53, 59] did not distinguish between costs of different conditions, further hindering the interpretation.”
From The economic impact of retinal diseases for which gene therapy is emerging: a systematic literature review (2025) · cites this paper as [52]
The Cost estimates section says the study estimated costs separately for four diabetic-retinopathy severity levels. Table 3 and the Discussion report distinct costs for background retinopathy, proliferative retinopathy, maculopathy, and their combination. Thus, this cited study did distinguish costs among the conditions it examined; our copy cannot establish what the other seven studies did. Page numbers were not available in our copy. (LLM, conf=0.87)
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Experimental — accuracy not yet measuredCosts associated with DMO were described in six studies for Spain (n = 2), Hungary, Italy, Sweden and the UK.
“Costs associated with DMO were described in six studies for Spain (n = 2) [55, 57], Hungary [54], Italy [56], Sweden [52] and the UK [58].”
From The economic impact of retinal diseases for which gene therapy is emerging: a systematic literature review (2025) · cites this paper as [52]
The Results report Swedish healthcare costs for diabetic maculopathy, and the Discussion compares those costs with studies of macular oedema. The paper does not identify its maculopathy category specifically as diabetic macular oedema (DMO), so it supports the Swedish cost-study citation but not that narrower description without qualification. (LLM, conf=0.82)
Experimental — accuracy not yet measuredAnnual direct medical costs ranged from $45 to $613 in NPDR patients and from $441 to $3,031 in PDR patients.
“Annual direct medical costs ranged from $45 to $613 in NPDR patients and from $441 to $3,031 in PDR patients (Fig. 5 and Supplementary Table 6), suggesting direct medical costs associated with PDR were about 5.8 times higher than those associated with NPDR.”
From The economic impact of retinal diseases for which gene therapy is emerging: a systematic literature review (2025) · cites this paper as [52]
The Results and Table 3 report annual additional healthcare costs by retinopathy severity, including €26 per patient for background retinopathy and €257 for PDR. They do not report the claimed NPDR and PDR dollar ranges; the Cost estimates section says this study converted costs to euros. (LLM, conf=0.84)
Experimental — accuracy not yet measuredDirect medical costs associated with PDR were about 5.8 times higher than those associated with NPDR.
“Annual direct medical costs ranged from $45 to $613 in NPDR patients and from $441 to $3,031 in PDR patients (Fig. 5 and Supplementary Table 6), suggesting direct medical costs associated with PDR were about 5.8 times higher than those associated with NPDR.”
From The economic impact of retinal diseases for which gene therapy is emerging: a systematic literature review (2025) · cites this paper as [52]
Table 3 and the Discussion report higher annual additional healthcare costs for PDR (€257) than for background retinopathy (€26). But the paper does not report a 5.8-fold PDR-to-NPDR comparison: its reported figures for PDR and background retinopathy yield about 9.9-fold, and it does not label the latter category NPDR. Page numbers were not available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAmong the four studies reporting direct medical costs at the patient level for DMO, estimates ranged from $370 to $14,642 per annum.
“Among the four studies reporting direct medical costs at the patient level, estimates ranged from $370 to $14,642 per annum [52, 54, 55, 57] (Fig. 6 and Supplementary Table 7).”
From The economic impact of retinal diseases for which gene therapy is emerging: a systematic literature review (2025) · cites this paper as [52]
The Results report annual patient-level healthcare costs for maculopathy, including €216 per patient, and the Cost estimates section defines the included medical costs. The paper does not report the stated $370–$14,642 range or establish the costs from all four cited studies. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Costs pertaining to DR and its complications (including DMO) were combined in three studies, whereas costs in patients affected by both DR and DMO simultaneously were reported in two studies.
“Costs pertaining to DR and its complications (including DMO) were combined in three studies [50, 51, 53], whereas costs in patients affected by both DR and DMO simultaneously were reported in two studies [52, 53] (Supplementary Tables 3 and 8).”
From The economic impact of retinal diseases for which gene therapy is emerging: a systematic literature review (2025) · cites this paper as [52]
The Cost estimates section calculates a cost for any DR, and Table 3 reports separate costs for maculopathy and for PDR combined with maculopathy. The latter supports a cost for patients with both conditions, but the paper does not identify maculopathy specifically as DMO or report a cost for all patients with DR and DMO simultaneously. Page numbers are not available in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredFor studies examining costs in patients affected by both DR and DMO, direct medical costs ranged from $742 to $2,955 per patient per annum.
“As for studies examining costs in patients affected by both DR and DMO [52, 53], direct medical costs ranged from $742 to $2,955 per patient per annum.”
From The economic impact of retinal diseases for which gene therapy is emerging: a systematic literature review (2025) · cites this paper as [52]
The Results and Table 3 report annual direct healthcare costs for patients with PDR and maculopathy combined, so this paper supports the claim that such costs were studied. Its estimate is €433 in additional healthcare costs per patient per year, however; our copy does not report the stated $742–$2,955 range or establish an endpoint of that range for this study. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThree studies, in Germany, Hungary and Sweden, estimated costs associated with NPDR and PDR.
“Three studies, in Germany [53], Hungary [54] and Sweden [52], estimated costs associated with NPDR and PDR (Fig. 5 and Supplementary Table 6).”
From The economic impact of retinal diseases for which gene therapy is emerging: a systematic literature review (2025) · cites this paper as [52]
Nine articles considered costs associated with DR and its associated complications (i.e. DMO).
“Nine articles [50–58] considered costs associated with DR and its associated complications (i.e. DMO).”
From The economic impact of retinal diseases for which gene therapy is emerging: a systematic literature review (2025) · cites this paper as [52]
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“a. Costs associated with non-proliferative diabetic (NPDR) and proliferative diabetic retinopathy (PDR) Three studies, in Germany [53], Hungary [54] and Sweden [52], estimated costs associated with NPDR and PDR (Fig.”
InfluentialKontinuerlig subkutan glukosmätning vid diabetes
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Cone Photoreceptor Structure and Function in Adolescents and Young Adults with Type 1 Diabetes
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- Authors
- Heintz, E., Wiréhn, A.-B., Peebo, B. B., Rosenqvist, U., & Levin, L.-Å.
- Affiliations
- Linköping University (SE)
- Ryhov Hospital Jönköping (SE)
- Lasarettet i Motala (SE)
- Corresponding author
- Heintz, E.
- Venue
- Diabetologia
- Published
- 2010-07-02
- Volume
- 53
- Issue
- 10
- Pages
- 2147-2154
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W1996708310
- Cited by
- 107
- References
- 27
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 7 · 2023: 4 · 2022: 4 · 2021: 15 · 2020: 8 · 2019: 7 · 2018: 6 · 2017: 9 · 2016: 5 · 2015: 6 · 2014: 6 · 2013: 9 · 2012: 8
- FWCI
- 6.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Funders
- AstraZeneca
- Länsstyrelsen Östergötland
- Linköpings Universitet
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- diabetic retinopathy, prevalence, health care costs, type 1 diabetes, type 2 diabetes, vision-threatening diabetic retinopathy, proliferative diabetic retinopathy, diabetic maculopathy, background retinopathy, retinopathy severity, cost per patient, Östergötland
- MeSH terms
- Cross-Sectional Studies, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Diabetic Retinopathy, Female, Humans, Male, Registries, Sweden, Prevalence, Health Care Costs
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