The increased cost of medical services for people diagnosed with primary open-angle glaucoma: a decision analytic approach.
OBJECTIVE
Glaucoma accounts for more than 11% of all cases of blindness in the United States, but there have been few studies of economic impact. We examine incremental cost of primary open-angle glaucoma considering both visual and nonvisual medical costs over a lifetime of glaucoma.


METHODS
A decision analytic approach taking the payor's perspective with microsimulation estimation.


METHODS
We constructed a Markov model to replicate health events over the remaining lifetime of someone newly diagnosed with glaucoma. Costs of this group were compared with those estimated for a control group without glaucoma. The cost of management of glaucoma (including medications) before the onset of visual impairment was not considered. The model was populated with probability data estimated from Medicare claims data (1999 through 2005). Cost of nonocular medications and nursing home use was estimated from California Medicare claims, and all other costs were estimated from Medicare claims data.


RESULTS
We found modest differences in the incidence of comorbid conditions and health service use between people with glaucoma and the control group. Over their expected lifetime, the cost of care for people with primary open-angle glaucoma was higher than that of people without primary open-angle glaucoma by $1688 or approximately $137 per year.


CONCLUSIONS
Among Medicare beneficiaries, glaucoma diagnosis not found to be associated with significant risk of comorbidities before development of visual impairment. Further study is necessary to consider the impact of glaucoma on quality of life, as well as aspects of physical and visual function not captured in this claims-based analysis.
Kymes
Steven M
SM
Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri 63110-1093, USA. kymes@vrcc.wustl.edu
Plotzke
Michael R
MR
Li
Jim Z
JZ
Nichol
Michael B
MB
Wu
Joanne
J
Fain
Joel
J
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D017281:Cost of Illness; D003661:Decision Support Techniques; D005260:Female; D005902:Glaucoma, Open-Angle / Q000191:economics*; D017048:Health Care Costs; D005102:Health Expenditures; D006302:Health Services Research; D006801:Humans; D008297:Male; D008390:Markov Chains; D006278:Medicare / Q000706:statistics & numerical data; D019057:Quality-Adjusted Life Years; D014481:United States; D014786:Vision Disorders / Q000191:economics*; D019987:Persons with Visual Disabilities