The cost of glaucoma care: Small group of patients accounts for large part of costs, study finds

A small subset of patients with open-angle glaucoma (OAG) account for a large proportion of all glaucoma-related charges in the United States, according to new data published by researchers at the University of Michigan Kellogg Eye Center and Washington University, St. Louis.

These findings have importance for future evaluations of the cost-effectiveness of screening and treatment for glaucoma.

“We've identified risk factors associated with patients who are the costliest recipients of glaucoma-related eye care,” says Joshua D. Stein, M.D., M.S., glaucoma specialist at Kellogg. “Among these factors are younger age, living in the northeastern United States, undergoing cataract surgery, and having other eye conditions. Understanding the characteristics of these individuals and finding ways to reduce disease burden and costs associated with their care can result in substantial cost savings.”

The study, published in the September 2012 issue of the American Journal of Ophthalmology, reviewed claims data from 19,927 patients with newly diagnosed OAG who were enrolled in a large U.S. managed care network.

The researchers identified glaucoma-related charges for all such patients from 2001 through 2009. They found that the costliest 5 percent of enrollees were responsible for $10,202,871, or 24 percent, of all glaucoma-related charges. They also found that glaucoma patients generally consume the greatest relative share of resources during their first six months of care after diagnosis.

“Although there have been several studies examining the cost of caring for patients with glaucoma, most have been based on individuals who have already been diagnosed, and few have examined changes in cost of care over time,” says Stein. “In this investigation, we examined two questions: What is the pattern of resource use for patients with OAG during the first seven years after disease onset, and what are the characteristics of those patients who have the greatest glaucoma-related resource use.”

A chronic, progressive, incurable disease that affects more than 2 million individuals in the United States and many more worldwide, OAG is the most common cause of blindness among African Americans. OAG is the most common form of glaucoma in the United States. Caring for patients with OAG in the United States carries a total societal cost estimated at nearly $1 billion annually.

“Developing an understanding of the resource use of people with glaucoma and identifying those expected to have the largest resource use is important in a resource-constrained health care environment,” says Stein. “Further, by collecting longitudinal information on resource use we can better quantify the value of slowing glaucoma progression through various interventions.”

Stein is a member of U-M's Institute for Healthcare Policy and Innovation, which brings together hundreds of U-M researchers who study and test ways to improve patient care.

Citation: Longitudinal Trends in Resource Use in an Incident Cohort of Open-Angle Glaucoma Patients: Resource Use in Open-Angle Glaucoma. American Journal of Ophthalmology, September, 2012.

Authors: Joshua D. Stein, M.D., M.S.; Leslie M. Niziol, M.S.; David C. Musch, Ph.D., M.P.H; Paul P. Lee, M.D., J.D.; Sameer V. Kotak, M.S.; Colleen M. Peters, M.A.; Steven M. Kymes, Ph.D.

For more information about glaucoma care and research at the Kellogg Eye Center, visit http://kellogg.umich.edu/patientcare/glaucoma.service.html