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A Multicenter, Retrospective Pilot Study of Resource Use and Costs Associated With Severity of Disease in Glaucoma
Paul P. Lee, MD, JD;
John G. Walt, MBA;
John J. Doyle, MPH;
Sameer V. Kotak, MS;
Stacy J. Evans, MD;
Donald L. Budenz, MD;
Philip P. Chen, MD;
Anne L. Coleman, MD, PhD;
Robert M. Feldman, MD;
Henry D. Jampel, MD, MHS;
L. Jay Katz, MD;
Richard P. Mills, MD, MPH;
Jonathan S. Myers, MD;
Robert J. Noecker, MD;
Jody R. Piltz-Seymour, MD;
Robert R. Ritch, MD;
Paul N. Schacknow, MD, PhD;
Janet B. Serle, MD;
Gary L. Trick, PhD
Arch Ophthalmol. 2006;124:12-19.
Objective To examine resource consumption and the direct costs of treating glaucoma at different disease severity levels.
Design Observational, retrospective cohort study based on medical record review.
Participants One hundred fifty-one records of patients with primary open-angle or normal-tension glaucoma, glaucoma suspect, or ocular hypertension (age  18 years) were randomly selected from 12 sites in the United States and stratified according to severity based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Patients had to have been followed up for a minimum of 5 years. Patients with concomitant ocular disease likely to affect glaucoma treatment–related resource consumption were excluded.
Methods Glaucoma severity was assessed and assigned using a 6-stage glaucoma staging system, modified from the Bascom Palmer (Hodapp-Anderson-Parrish) system. Clinical and resource use data were collected from the medical record review. Resource consumption for low-vision care and vision rehabilitation was estimated for patients with end-stage disease based on specialist surveys. For each stage of disease, publicly available economic data were then applied to assign resource valuation and estimate patient-level direct costs from the payer perspective.
Main Outcome Measures Average annual resource use and estimated total annual direct cost of treatment were calculated at the patient level and stratified by stage of disease. Direct costs by specific resource types, including ophthalmology visits, glaucoma surgeries, medications, visual field examinations, and other glaucoma services, were also assessed.
Results Direct ophthalmology-related resource use, including ophthalmology visits, glaucoma surgeries, and medication use, increased as disease severity worsened. Average direct cost of treatment ranged from $623 per patient per year for glaucoma suspects or patients with early-stage disease to $2511 per patient per year for patients with end-stage disease. Medication costs composed the largest proportion of total direct cost for all stages of disease (range, 24%-61%).
Conclusions The study results suggest that resource use and direct cost of glaucoma management increase with worsening disease severity. Based on these findings, a glaucoma treatment that delays the progression of disease could have the potential to significantly reduce the health economic burden of this chronic disease over many years.
Author Affiliations: Duke University Medical Center, Durham, NC (Dr Lee); Allergan, Inc, Irvine, Calif (Mr Walt); The Analytica Group, New York, NY (Messrs Doyle and Kotak and Dr Evans); University of Miami, Miami, Fla (Dr Budenz); University of Washington, Seattle (Dr Chen); Jules Stein Eye Institute, University of California, Los Angeles (Dr Coleman); University of Texas, Houston (Dr Feldman); The Johns Hopkins University, Baltimore, Md (Dr Jampel); Wills Eye Hospital, Philadelphia, Pa (Drs Katz and Myers); University of Kentucky, Lexington (Dr Mills); University of Arizona, Tucson (Dr Noecker); University of Pennsylvania Health System, Philadelphia (Dr Piltz-Seymour); New York Eye & Ear Infirmary, New York (Dr Ritch); Palm Beach Eye Foundation, Lake Worth, Fla (Dr Schacknow); Mount Sinai School of Medicine, New York (Dr Serle); Henry Ford Health System, Detroit, Mich (Dr Trick).
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