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Editors Selection IGR 9-4

Cost of glaucoma management

Comment by Douglas Anderson on:

13452 A multicenter, retrospective pilot study of resource use and costs associated with severity of disease in glaucoma, Lee PP; Walt JG; Doyle JJ et al., Archives of Ophthalmology, 2006; 124: 12-19

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The costs for care as currently provided within the USA were estimated by Lee et al. (271) from records of 151 patients who remained under care for five years in 12 ophthalmic practices (most focused on glaucoma). Disease severity ranged from stage 0 (ocular hypertension) to stage 5 (end-stage). The amount of care provided was tabulated (such as office visits, visual fields, medications prescribed, surgery performed, and other services). The cost for services was estimated according to the usual payments from third parties, and for medications from Red Book wholesale prices. Two-thirds of the patients were between age 60 and 80 years old, about 25% of the patients progressed to a more severe stage in five years. There were approximately equal numbers of patients at each stage in the analysis. For all stages, there is a pedestal of cost for office visits and visual fields and minor additional services of approximately $400 annually, perhaps slightly less in those with ocular hypertension. The second component of cost is therapy (medical and surgical), adding about $200 annually to care for those with ocular hypertension and $800 to $1100 for those with stages 1 through 3. In stages 4 and 5 there is an additional $400 cost, mainly for surgery in stage 4 and for low vision services in stage 5.

Cost of glaucoma management vary from USD 600 to 1900 depending on stage

A tentative argument is made that more assertive therapy in early stages may avoid the higher costs in more advanced stages. The final decision about an optimal strategy of care must await combining the present invaluable data with information about the relative frequency of various stages and whether the additional expense of more assertive therapy in a large number with ocular hypertension and mild disease offsets the ultimate saving by having fewer patients with advanced disease. More difficult to determine is whether the current practice pattern (frequency of visits, fields, etc.) is appropriate for each stage. Finally, non-monetary considerations (natural history of the disease, effectiveness of various treatments in slowing progression, impairment and life-quality at various stages of disease, etc.) need be in the formula to optimize the plan of care of patients with glaucoma or at risk for glaucoma.

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