Total and Disease Specific Resource Use and Healthcare Cost of Patients with Glaucoma
<bold>Introduction</bold> Glaucoma is an irreversible, progressive, optic neuropathy. Left unmanaged, glaucoma can lead to blindness. Open angle glaucoma is the most common type, and primary (idiopathic) open angle glaucoma (POAG) is the most common sub-type. POAG was estimated to affect almost 3 million Americans in 2010. Surgical and medical interventions can be employed to manage the progression of disease and help prevent blindness. Previous literature has estimated the utilization and financial burden of disease, with a few studies also reporting outcomes as vision loss worsens, but few have included drug claims. The primary objective of this study was to characterize the overall and disease-related healthcare resource use, including drug utilization, and cost associated with treatment and care provided to glaucoma patients. <bold>Methods</bold> A retrospective analysis of a US commercial claims database was performed. Patients were stratified into vision loss categories of no vision loss, mild, moderate, or severe vision loss and blindness using two different classification systems. Outcomes of interest were frequency and mean cost of specific service categories, unadjusted and adjusted mean annual total healthcare cost and unadjusted and adjusted mean annual cost of glaucoma specific care. Outcomes were reported over one year following the diagnosis of glaucoma. <bold>Results</bold> Few patients were identified as having vision loss, as determined by the two classification schemes employed (Javitt or ICD-9). In general, the frequency of total healthcare and glaucoma specific services increased from the pre-index period to the post-index period. The magnitude of increase was higher for vision related services. Overall, the unadjusted mean total healthcare cost per patient and unadjusted mean glaucoma specific cost per patient increased from pre-index to post-index period for all vision loss categories. There was no trend observed for unadjusted mean total healthcare cost or unadjusted mean glaucoma specific cost as vision loss progressed. Adjusted cost ratios for total healthcare cost and glaucoma specific cost did not result in a trend as vision loss progressed. <bold>Conclusion</bold> We characterized total healthcare and glaucoma specific utilization and cost for patients during the 12 months prior to and 12 months following their glaucoma diagnosis. We found that utilization and cost of services increased from the pre-index period to the post-index period. But, we were unable to detect a trend in adjusted total healthcare and adjusted glaucoma specific cost as vision loss progressed. Future work to increase the cohort size, specifically to include older patients, may improve our ability to detect a trend as vision loss progresses.