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Editors Selection IGR 16-4

Cost End-stage Glaucoma

Comment by David Friedman on:

21472 Late-stage, primary open-angle glaucoma in Europe: social and health care maintenance costs and quality of life of patients from 4 countries, Thygesen J; Aagren M; Arnavielle S et al., Current Medical Research and Opinion, 2008; 24: 1763-1770

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Thygesen et al. (1275) present an analysis of the costs of caring for patients with end-stage glaucoma in four European countries (Germany, France, England and Denmark). One hundred and sixty-two (162) patients with a minimum follow-up of one year and a mean follow-up of 3.3 years were identified from low vision clinics in these countries (most were from Denmark and Germany). A retrospective chart review was combined with a prospective assessment of quality of life (QoL) to determine both costs of care and the impact of glaucomatous vision loss on QoL. Visual field data were not available, so vision assessment was solely based on Snellen acuity. Medical costs included both the cost of medications and office visits as well and the cost of visual rehabilitation visits. Excluded were the costs of visual field testing and the costs of low vision aids. The reliance on home help aids was also calculated separately. Total costs of medicine and rehabilitation visits were similar across the four countries, but home help was one-fifth as costly in Germany when compared to the other three countries. Large variation in the use of low vision devices was also seen (e.g., none of the patients in England used CCTV versus about one-third in other countries while canes were used in over 80% of English and only 10% of German patients). The study also found that patient self-reported QoL was associated with the visual acuity in the betterseeing eye. Costs were higher for those with better visual acuity in the better-seeing eye, mainly due to higher costs for medications. The study estimated that the total cost of care for glaucoma patients with late stage disease under care by low vision services ranged from 1,400 Euros in Germany to 5,800 Euros in France (where best eye visual acuity was the lowest). This study has several important limitations. Firstly, the costs were not completely determined (e.g., low vision aids were not included) and therefore the estimates are likely lower than true costs. Secondly, opportunity costs of visits to healthcare providers and costs of lost productivity of patients and caregivers are not included, also underestimating the true costs to society. Finally, the patient population is inherently biased in favor of those who utilize healthcare services since all patients were selected from low vision services. It is highly likely that many with low vision from glaucoma do not access these services and that those who do are more likely to consume other resources (such as home health) than those who do not. This would tend to overestimate the costs to society of these patients. In summary, the authors have made an important contribution to our understanding of the costs associated with caring for persons severely impaired by glaucoma. Further studies looking at the economic impact associated with decreased productivity of the visually impaired and their caregivers will be necessary to determine the true impact of vision impairing glaucoma.

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