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Editors Selection IGR 19-3

Health economics: Cost of glaucoma

Comment by George Lambrou on:

20959 Health care charges for patients with ocular hypertension or primary open-angle glaucoma, Pasquale LR; Dolgitser M; Wentzloff JN et al., Ophthalmology, 2008; 115: 633-638

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In an era when the combined effects of increased life expectancy and more sophisticated and expensive diagnostic or treatment pro-cedures are creating increasing pressure on health care resources, strategies will need to be developed to deliver medical care in the most cost-effective way compatible with medical ethics and society needs. Such strategies will necessarily be based on large health-economic studies that evaluate the cost of diseases and of their potential therapies. Pasquale et al. (899) conducted one such study for patients with ocular hypertension (OH) and primary open-angle glaucoma (POAG). Data were obtained from a large de-identified health-insurance database containing information on 50 million covered lives. Cohorts of OH (n = 36767) and POAG patients (n = 72412) were identified, based on at least two appropriate ICD9 diagnosis codes, and followed between the years 1998 and 2005. They evaluated total health care (THC) charges and condition-related (CR) charges and tried to identify the factors that influence OH- and POAG-related health-care charges.

The mean observed POAG-related annual charge (US$1449 per patient) was higher than the percapita gross national income of 77 out of 187 countries evaluated in 2004

Both THC and CR charges were significantly higher for POAG than for OH (THC mean: $15021 vs. $11592; median: $5994 vs. $4677. CR mean $1449 vs. $429; median $875 vs. $305 ‐ all numbers are US$ per patient per year, adjusted for inflation). THC charges increased steadily with age for both conditions whereas CR charges did not. Of particular interest is the observation that the mean observed POAG-related annual charge ($1449 per patient) was higher than the per-capita gross national income of 77 out of 187 countries evaluated in 2004. Several sources of higher CR charges for POAG were identified, including increased occurrences of diagnostic (visual fields, scanning laser ophthalmoscopy, comprehensive eye exams) or therapeutic procedures (eyedrops, trabeculectomy, trabeculoplasty). Ocular and systemic comorbidities were significantly associated with higher THC and ocular comorbidities with higher CR as well. The authors concluded that both THC and CR charges are considerable for patients with OH and POAG and that opportunities for reducing condition-related charges associated with the transition from OH to POAG need to be explored.

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