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Editors Selection IGR 7-3

Lifetime outcome in glaucoma

Comment by Mary Gilbert Lawrence on:

13068 Direct costs of glaucoma and severity of the disease: a multinational long term study of resource utilisation in Europe, Traverso CE; Walt JG; Kelly SP et al., British Journal of Ophthalmology, 2005; 89: 1245-1249

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In the study, funded by Allergan, Traverso et al. (1144) addressed the critically important issue of resource utilization and direct costs of glaucoma management. The investigators, two of whom were Allergan employees, assessed number and type of eye care visits and interventions, as well as costs over time, for each of six severity levels of the disease. The investigators performed a retrospective chart review of 194 charts from sites in five European countries, Austria, France, Germany, Italy, and the UK. They used the Bascom Palmer (Hodapp-Anderson-Parrish) glaucoma staging system to assign an equivalent number of patients to each severity stage. Approximately 32 patients were identified for each of the six severity stage groups. Every patient had to have been followed for a minimum of five years. The number of ophthalmologist office visits, quantity and type of medications prescribed, number of surgical procedures performed, and all clinical tests including visual fields, gonioscopy, disc photographs, diurnal IOP curves, retinal nerve fiber layer analyses, etc. were extracted from each chart. Health economists from each of the five countries were consulted to provide unit costs associated with each office visit, clinical test, surgery, and medication. The results showed that with increasing glaucoma severity, both resource utilization and total direct costs rose significantly. Direct costs increased from Euro 455 per person year for ocular hypertension (stage 0) to Euro 969 for severe glaucoma (stage 4).

The results showed that with increasing glaucoma severity, both resource utilization and total direct costs rose significantly. Direct costs increased from Euro 455 per person year for stage 0 to Euro 969 for stage 4 across Europe

Interestingly, patients with end-stage glaucoma/blind (stage 5), were less costly than severe glaucoma (stage 4), presumably because they had previously failed to respond to medications, had already undergone several surgical procedures with suboptimal results, and had little to no useful vision left to aggressively preserve. Medications were the largest single component of cost at every disease stage, representing a minimum of 42% of the total direst cost of disease management. Based on their results, Traverso and coworkers suggested that effective management of early stage glaucoma, delaying progression of the disease, would be expected to significantly reduce the economic burden of glaucoma. The major flaws of this study were its small size, with approximately 32 patients per severity group, and selection bias, with respect to both the participating sites as well as the individual patients included. Variations in glaucoma care between ophthalmology centers and/or countries may have significantly impacted the cost analysis, but were not noted. Although the project had design flaws, the authors are to be commended for addressing the important topic of resource utilization and cost analysis of this leading cause of worldwide blindness.

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