Cost of the medical management and prescription pattern for primary open angle glaucoma (POAG) in Ghana–a retrospective cross-sectional study from three referral facilities

Abstract

BackgroundGlaucoma is the leading cause of irreversible blindness globally, and treatment involves considerable cost to stakeholders in healthcare. However, there is infrequent availability of cost information and patterns of management, especially in developing countries. This study determined the cost of the medical management of POAG, adherence, and pattern of medication prescription in Ghana.MethodsA retrospective cross-sectional study involving 891 Primary Open Angle Glaucoma (POAG) cases seen in the year 2012 at three referral facilities. Demographics, ocular history, resource consumption, medication, test, surgery and other related cost were extracted from 84 patients who had fully complied with their treatment to calculate total cost (TC) based on 2012 estimates. Glaucoma drugs prescribed to patients who had adhered to all their review visits within the period evident from case folders were recorded and analysed for the prescription pattern.ResultsOut of 891 POAG cases seen in 2012, 351(39.4 %) attended all the required review visits, but only 84 (9.4) had fully and continually adhered to all their treatment regimes. They comprised 41(48.8 %) males and 43(51.2 %) females with a mean age of 65 ± 14.8. Majority of the respondents were elderly above 60 year of age (65.5 %). The total estimated cost for the 84 cases in the year was GH¢ 81,237 ($40,619), comprising GH¢ 72,193 ($36,097) direct medication cost and GH¢9,045 ($4,523) direct non-medication cost (surgery and test cost), and an average of GH¢ 967 ($484) for a mean visit of 5.6 ± 1.1 in the year. A total of 673 glaucoma medications had been prescribed for 351 patients for the year, with timolol being the most prescribed (64.19 %) and monotherapy as the most adopted form of therapy (61.06 %). Age and income showed concurrent increase with cost (P ≤ 0.05).ConclusionsCost of managing glaucoma constitutes a substantial financial burden and influenced the pattern of medication prescription.

Cost Analysis and Rational Use of Anti Glaucoma Therapy in A Tertiary Hospital in Ghana

“…Even though sex did not play any role in glaucoma as illustrated in these studies [2,30], in our study there were more prescriptions given to female (52.7%%) than male (47.2%) clients. Similar result was reported in another study in Ghana [31] and other studies in India [32,33]. This calls for further and most probably larger studies to ascertain the role played by gender among Ghanaian patients with glaucoma.…”

“…Finally our study showed that the highest cost of glaucoma treatment per prescription per annum is US$ 420. This is similar to a study done in Ghana [31] that looked amongst other things at the cost of glaucoma medications.…”

“…Similar patterns regarding beta-blocker usage have been reported [42,39]. Only 1.4% patients were put on miotics or para-sympathomimetic in our study, these were class of drugs that are not preferred now for the management of glaucoma because of the commonly associated side-effects like diminished night vision, reduced visual acuity, opacities, myopia and visual eld contraction hence its low patronage by prescribers [39] and very few studies reported its usage [31] .There is clear indication of its usage gradually diminishing in the treatment of glaucoma as indicated in our study.…”

Epidemiology and clinical presentation of glaucoma in a referral facility in Ghana: Any lessons for public health intervention?

“…There is a gradual shift from the use of beta-blockers as the first line of treatment for glaucoma in Ghana as prostaglandins analogs are now listed as essential drugs in Ghana and are therefore covered by the National Health Insurance Scheme [ 18 , 19 ]. That notwithstanding, there is still a comparable usage of beta-blockers ( Table 5 ).…”

“…The prevalence of glaucoma cases reporting to a referral facility can therefore serve as a fair benchmark for evaluating the eye care-seeking behavior and the coverage of care for glaucoma. Available studies [ 11 – 18 ] in Ghana have amply dealt with the prevalence, risk factors, and to some extent the genetics of glaucoma but there remains a paucity of information on the epidemiology and clinical profile of patients living with glaucoma and receiving care in health care facilities. There is a recent study [ 19 ] on the epidemiological data among patients with Glaucoma and receiving care in a referral facility in the Ashanti region.…”