Glaucoma in the United States and europe: predicting costs and surgical rates based upon stage of disease.
OBJECTIVE
Primary open-angle glaucoma is a significant health-economic burden in both the United States and Europe that is likely to increase. This study compared treatment patterns and cost among patients with primary open-angle glaucoma in these locations.


METHODS
Retrospective medical chart reviews were conducted in the United States (1990 to 2002) and Europe (1995 to 2003). A total sample of 151 US charts and 194 European charts was studied, and patients were assigned a baseline intraocular pressure (IOP) and baseline stage, using a 6-stage visual functional glaucoma staging algorithm. Resource utilization and direct costs were assessed by stage of disease using publicly available United States and European costs. Cox Proportional Hazards modeling were used to examine covariates predicting glaucoma surgery. Total cost was predicted, adjusting for covariates using Generalized Linear Models, with baseline stage as the independent variable.


RESULTS
Glaucoma surgery requirement was highly associated with baseline disease stage and IOP increase before surgery in the United States and somewhat associated with these factors in Europe. Within both locations, baseline IOP was highly associated with glaucoma surgery requirement. Controlling for covariates, patients at higher baseline stages incurred greater costs in the United States (P=0.0017) and Europe (P=0.0715). Surgery and medication were also highly predictive of increased cost (P<0.0001). Cost of care differed greatly between the European countries, with costs lowest in Italy.


CONCLUSIONS
Increases in annual cost were related to higher baseline IOP, higher baseline stage, medication, and surgery. Thus, significant potential savings and reductions in annual healthcare burden are possible if patients are diagnosed and treated at earlier stages of glaucoma.
Lee
Paul P
PP
Duke University, Durham, NC, USA.
Kelly
Simon P
SP
Mills
Richard P
RP
Traverso
Carlo E
CE
Walt
John G
JG
Doyle
John J
JJ
Katz
Laura M
LM
Siegartel
Lisa R
LR
D000368:Aged; D000959:Antihypertensive Agents / Q000191:economics*; D017281:Cost of Illness; D018450:Disease Progression; D004470:Economics, Medical; D005060:Europe; D005260:Female; D018463:Filtering Surgery / Q000191:economics*; D005902:Glaucoma, Open-Angle / Q000191:economics* / Q000503:physiopathology* / Q000628:therapy; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States
D000959:Antihypertensive Agents