title: Costs and utilization of end-stage glaucoma patients receiving visual rehabilitation care: a US multisite retrospective study.
abstract: OBJECTIVE
  Glaucoma is a prevalent ophthalmologic disease and leading cause of blindness. A retrospective analysis was conducted to evaluate resources and costs for end-stage glaucoma patients receiving visual rehabilitation care (VRC).
  
  
  METHODS
  A chart review was conducted in 3 United States VRC centers. Charts of patients with primary open-angle glaucoma as the primary cause of vision loss (1998 to 2003) were selected, yielding 81 records. Data were collected from patient-level billing and reimbursement records (ophthalmologist/optometrist visits, glaucoma medications, procedures, and specialized low-vision and glaucoma-related services). Visual rehabilitation services included utilization of low-vision devices, assessment of daily functioning, orientation and mobility training, and patient counseling.
  
  
  RESULTS
  Mean age at baseline was 72.7 years [standard deviation (SD)=17.2, range: 29 to 95]. Of those with known sex (n=77), 55.8% were women. Medicare was the payer type for most patients (59.3%), whereas 20% had Medicaid. Mean number of visits was 7.1 (SD=6.1) in year 1 and 3.7 (SD=4.2) in year 2, for an annual mean of 5.4 (SD=5.0) visits overall. Total mean cost per patient in year 1 was greater than year 2 [$2170 (SD=$2252) vs. $1202 (SD=$1080), respectively]; of the total 2-year costs, 15% were VRC, 37% ophthalmology care, and 48% pharmacy. Analysis of nonpharmacy costs revealed that VRC accounted for 28% and ophthalmology for 72%.
  
  
  CONCLUSIONS
  End-stage glaucoma is associated with appreciable resource utilization and costs, because of both vision rehabilitation and ophthalmology care. Advanced primary open-angle glaucoma has a substantial cost-of-illness, warranting improved management in early stages of disease.
authors.affiliation: Wheaton Eye Clinic, Wheaton, IL, USA.
authors.forename: David K
authors.initials: DK
authors.lastname: Gieser
authors.forename: R
authors.initials: R
authors.lastname: Tracy Williams
authors.forename: William
authors.initials: W
authors.lastname: O'Connell
authors.forename: Louis R
authors.initials: LR
authors.lastname: Pasquale
authors.forename: Bruce P
authors.initials: BP
authors.lastname: Rosenthal
authors.forename: John G
authors.initials: JG
authors.lastname: Walt
authors.forename: Laura M
authors.initials: LM
authors.lastname: Katz
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Siegartel
authors.forename: Lujing
authors.initials: L
authors.lastname: Wang
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Rosenblatt
authors.forename: Lee S
authors.initials: LS
authors.lastname: Stern
authors.forename: John J
authors.initials: JJ
authors.lastname: Doyle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000191:economics / Q000534:rehabilitation; D017281:Cost of Illness; D005260:Female; D005902:Glaucoma, Open-Angle / Q000191:economics* / Q000534:rehabilitation*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012682:Sensory Aids / Q000706:statistics & numerical data; D014481:United States; D015354:Vision, Low / Q000191:economics / Q000534:rehabilitation