title: Direct cost and predictive factors for treatment in patients with ocular hypertension or early, moderate and advanced primary open-angle glaucoma: the CoGIS study in Germany.
abstract: BACKGROUND
  The main objectives of this analysis were to assess the treatment costs and to identify major cost drivers and factors predicting direct costs in German patients with ocular hypertension (OHT) or primary open-angle glaucoma (POAG).
  
  
  METHODS
  This non-interventional cross-sectional study was conducted in two university hospitals and 13 ophthalmology practices in Germany regions (Bavaria, Rhineland-Palatinate, North Rhine-Westphalia, Hamburg and Mecklenburg-Western Pomerania) between May 2009 and January 2010 to assess resource utilisation in patients with OHT (ICD-10: 40.0) or POAG (ICD-10: 40.1) at early, moderate or advanced stages, according to the European Glaucoma Society classification Guidelines. Treatment patterns and direct costs were evaluated retrospectively for 5 years. Resource utilisation data (medication, hospitalisation, outpatient surgery, visits to ophthalmologists) were abstracted from the charts, and unit costs were applied to estimate direct costs per year (in Euros, 2009), calculated from the perspective of the statutory health insurance in Germany (Gesetzliche Krankenversicherung). Factors predicting costs were assessed in multivariate regression analysis.
  
  
  RESULTS
  One hundred and fifty-four patients (17.5% OHT, 27.9% early, 22.7% moderate, and 31.8% advanced POAG), on average 67 years old (SD 11) were included in the study. Average total annual direct costs per patient for OHT were <euro>226 (SD 117), for early POAG <euro>423 (SD 647), moderate <euro>493 (SD 385) and advanced POAG <euro>809 (SD 877). Glaucoma-related medications and hospitalisation represented the two major components of direct costs, increasing with the progression of glaucoma. In addition to treatment switches (p = 0.0001), factors predictive of an increase in total direct costs included the number of hospital interventions (p < 0.0001), disease-state changes since the start of treatment (p = 0.05), and current disease state (p = 0.05).
  
  
  CONCLUSIONS
  Direct costs of treatment are higher in glaucoma compared to OHT and further increase in more severe glaucoma states. Additional treatment changes are major contributing factors to the increased treatment costs of glaucoma. If intraocular pressure can be controlled over the long term, progression to moderate and advanced states avoided, and patients remain on initial treatments, treatment costs could decline due to reduced and less expensive healthcare resource utilisation.
authors.affiliation: Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany. katrin.lorenz@unimedizin-mainz.de
authors.forename: Katrin
authors.initials: K
authors.lastname: Lorenz
authors.forename: Christian
authors.initials: C
authors.lastname: Wolfram
authors.forename: Lusine
authors.initials: L
authors.lastname: Breitscheidel
authors.forename: Margarita
authors.initials: M
authors.lastname: Shlaen
authors.forename: Yves
authors.initials: Y
authors.lastname: Verboven
authors.forename: Norbert
authors.initials: N
authors.lastname: Pfeiffer
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000191:economics; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use; D015897:Comorbidity; D003430:Cross-Sectional Studies; D018450:Disease Progression; D016527:Drug Costs; D005260:Female; D018463:Filtering Surgery / Q000191:economics / Q000379:methods; D005858:Germany; D005902:Glaucoma, Open-Angle / Q000145:classification / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D009885:Ophthalmology / Q000191:economics*; D012189:Retrospective Studies; D014065:Tonometry, Ocular; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents