Direct healthcare cost and barriers to the medical management of primary open-angle glaucoma in healthcare facilities in Yaounde – Cameroon

Abstract

Objectives: The objective of this study was to estimate the direct healthcare cost of glaucoma among patients attending two healthcare services in Yaounde, Cameroon. Materials and Methods: This investigation was a hospital-based, observational, and cross-sectional study of 122 glaucoma patients on follow-up from January to August 2021. The study was carried out using a pre-tested questionnaire and analyzed sociodemographic and clinical characteristics, monthly income, investigations performed, medications prescribed, and direct healthcare costs. Data were analyzed using the Statistical Package for the Social Sciences version 24. Results: A total of 122 glaucoma follow-up patients participated in the study of whom 73 (59.9%) were male (sex ratio M/F = 1.49). Seventy-one (58.19%) participants were above 60 years. The majority (67.4%) had a higher education level. Over 40% of participants reported a monthly income of <228 Euros. Only 38 (31.1%) had health insurance. During the study year, each patient underwent 2.25 ± 0.84 consultations, 2.76 ± 1.40 ocular pressure measurements, 0.73 ± 0.52 visual field examinations, and 0.32 ± 0.2 gonioscopy. Prostaglandin analogs were the most widely prescribed drugs (71%), followed by β-blockers (Carteolol and Timolol) and carbonic anhydrase inhibitors with frequencies of 62% and 15%, respectively. The direct medical cost of the study population was estimated at 468.47 ± 155.34 Euros. The greatest proportion of out-of-pocket expenses (61.13% of medical costs) concerned the purchase of drugs, with an average cost of 284.16 ± 115.25 Euros. Patients treated in the public sector spent an average of 425.78 ± 38.49 Euros, while those treated in the private sector spent 562.22 ± 139.18 Euros during the study year (P = 0.001). However, health coverage and type of glaucoma did not influence the direct cost of treatment. The main obstacles to glaucoma care were insufficient income followed by forgetfulness. Conclusion: The present study shows that almost all participants self-funded their glaucoma management. More than 60% of the direct healthcare cost was devoted to anti-glaucoma drugs and the main barrier to optimal glaucoma care was the lack of financial resources. All stakeholders need involvement, especially health policymakers, to prioritize glaucoma management to make it affordable for patients.

Epidemiological, Clinical, Therapeutic and Evolutive Profile of Primary Open-Angle Glaucoma in a Cameroonian Population

“…These results are similar to those of Eballe et al [12] and Sounouvou et al [14] in Benin, who observed a predominance of beta-blockers use at 77% and 54%, respectively. However, Domngang et al, in 2023, found monotherapy, in 60% of cases, with prostaglandin agonists as the most prescribed treatment from a hospital based study carried out in an urban area in Cameroon [9].…”

“…According to Kyari et al, glaucoma treatment options are limited by the low availability of drugs and equipment, the lack of adequate surgical and diagnostic skills and the high cost of treatment [4]. Domngang et al, reported in a study carried out in Cameroon on the management of POAG, that 61% of the annual direct cost is attributable to the purchase of antiglaucomatous drugs [9]. In addition, this study highlighted certain factors that may justify a poor compliance during medical treatment, as the low rate of patients with health insurance.…”

“…[9]. Thus, the present work aimed to assess the epidemiological, clinical, therapeutic and evolutive profile of patients with POAG in two health facilities in the West Cameroon region.…”