A Multicenter, Retrospective Pilot Study of Resource Use and Costs Associated With Severity of Disease in Glaucoma

Abstract

To examine resource consumption and the direct costs of treating glaucoma at different disease severity levels. Design: Observational, retrospective cohort study based on medical record review. Participants: One hundred fifty-one records of patients with primary open-angle or normal-tension glaucoma, glaucoma suspect, or ocular hypertension (age Ն18 years) were randomly selected from 12 sites in the United States and stratified according to severity based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Patients had to have been followed up for a minimum of 5 years. Patients with concomitant ocular disease likely to affect glaucoma treatment-related resource consumption were excluded. Methods: Glaucoma severity was assessed and assigned using a 6-stage glaucoma staging system, modified from the Bascom Palmer (Hodapp-Anderson-Parrish) system. Clinical and resource use data were collected from the medical record review. Resource consumption for low-vision care and vision rehabilitation was estimated for patients with end-stage disease based on specialist surveys. For each stage of disease, publicly available economic data were then applied to assign resource valuation and estimate patientlevel direct costs from the payer perspective. Main Outcome Measures: Average annual resource use and estimated total annual direct cost of treatment were calculated at the patient level and stratified by stage of disease. Direct costs by specific resource types, including ophthalmology visits, glaucoma surgeries, medications, visual field examinations, and other glaucoma services, were also assessed. Results: Direct ophthalmology-related resource use, including ophthalmology visits, glaucoma surgeries, and medication use, increased as disease severity worsened. Average direct cost of treatment ranged from $623 per patient per year for glaucoma suspects or patients with early-stage disease to $2511 per patient per year for patients with end-stage disease. Medication costs composed the largest proportion of total direct cost for all stages of disease (range, 24%-61%). Conclusions: The study results suggest that resource use and direct cost of glaucoma management increase with worsening disease severity. Based on these findings, a glaucoma treatment that delays the progression of disease could have the potential to significantly reduce the health economic burden of this chronic disease over many years.

The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation

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Cost-utility of primary open-angle glaucoma in Brazil

“…[1][2][3][4] The laser trabeculoplasty postpones the introduction of eyedrops in the treatment of patients, thus reducing the direct medical costs.…”

“…[1][2] It is known that health care costs related to glaucoma tend to increase with the severity of the disease and when the diagnosis is made in late stages of the disease. [3][4] The availability of new methods of treatment and diagnosis imposes questions about how to best allocate resources. The technology assessment in health has become important for a number of reasons: great variability of clinical practice, uncertainty about the actual impact of certain diagnostic or therapeutic interventions, rapid development and diffusion of new technologies and incompatibility among new technologies and the ones already established.…”

Perfil socioeconômico dos portadores de glaucoma no serviço de oftalmologia do hospital universitário da Universidade Federal de Juiz de Fora - Minas Gerais - Brasil

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