Because of population aging, the incidence of age-related macular degeneration (AMD) and diabetic macular edema (DME) is gradually rising; concomitantly, the use of anti-vascular endothelial growth factor (anti-VEGF) therapy, which is standard therapy for these diseases, is also increasing consistently. Spending for National Health Insurance (NHI) in Korea has grown continuously, reaching KRW 347.5 billion in 2015, and is expected to rise further. Because of the large budget impact, under NHI, the reimbursement of anti-VEGF therapy was limited to 14 times during a persons’ lifetime until as recently as November 2017. Although AMD and DME are chronic diseases that require the therapy persistingly, the limited number of reimbursement resulted in the transference of a greater financial burden to the patient. For this reason, the reimbursement condition was lifted since December 1, 2017; instead, this limitation was revised such that the anti-VEGF therapy payments are no longer provided when corrected visual acuity is 0.1 or less even after each anti-VEGF drugs are administered five times. This new payment requirement is expected to change the patients’ out of pocket and insurance spending in the future for the treatment of AMD and DME. This study aimed to examine related evidence for more effective and efficient policy implementation in the future.  

To compare and evaluate the efficacy and safety of anti-VEGF therapy on AMD or DME, two of the most burdensome retinal diseases, and analyze the budget impact of a newly established reimbursement requirement.