Product information and disease description Place of product in therapy Disease description Burden of Open-angle glaucoma or ocular hypertension

Economic burden and healthcare resource utilization

15 evidence topics · 12 sources

United States incremental health care expenditures: Medical Expenditure Panel Survey, 2016 to 2018

“After 1:3 propensity matching for sociodemographics and the Charlson Comorbidity Index, this study analyzed 1521 glaucoma patients (mean expenditures: $13,585.68±1367.03) and 4563 patients without glaucoma (mean expenditures: $12,048.92±782.49).” (opens the source at this quote in a new tab)
“Controlling for comorbidities and socioeconomic factors, propensity-matched glaucoma patients incur an annual incremental health care burden of $1863.17 (95% confidence interval, 393.44-3117.23, P=0.013), translating into an additional $9.2 billion in population-level US health care expenditures. By health care service sector, the expenditure ratio for health care expenditures was higher for prescription medications (expenditure ratio=1.20, 95% confidence interval, 1.02-1.42, P=0.031).” (opens the source at this quote in a new tab)

United States costs by disease severity: commercial claims analysis

“One hundred seventy-seven thousand three hundred fifty-two OHT and OAG patients were identified (67.8% with OAG). Open-angle glaucoma patients showed higher eye-related outpatient costs than OHT patients (median, $516 [interquartile range (IQR), $323-$898] vs. $344 [IQR, $197-$617], respectively). Patients with severe OAG showed higher eye-related outpatient costs than moderate and mild OAG patients (median, $639 [IQR, $381-$1264] vs. $546 [IQR, $345-$950] vs. $476 [IQR, $304-$765], respectively; P < 0.0001), as well as higher glaucoma-related pharmacy costs (median, $493 [IQR, $122-$1457] vs. $244 [IQR, $84-$1113] vs. $139 [IQR, $66-$818], respectively; P < 0.0001). In adjusted analyses, disease worsening was associated with at least 2-fold higher annual eye-related outpatient costs (P < 0.0001).” (opens the source at this quote in a new tab)

United States direct costs by disease stage: multicenter medical record review

“Direct ophthalmology-related resource use, including ophthalmology visits, glaucoma surgeries, and medication use, increased as disease severity worsened. Average direct cost of treatment ranged from $623 per patient per year for glaucoma suspects or patients with early-stage disease to $2511 per patient per year for patients with end-stage disease. Medication costs composed the largest proportion of total direct cost for all stages of disease (range, 24%-61%).” (opens the source at this quote in a new tab)

Guideline summary of direct and indirect costs

“The costs of managing a chronic disease like glaucoma can be broken down into direct medical costs, direct nonmedical costs, and indirect costs.” (opens the source at this quote in a new tab)
“One study from 2005 estimated that nearly $3 billion per year was spent in the United States on direct medical costs from glaucoma.” (opens the source at this quote in a new tab)
“Using Medicare claims data and Markov modeling, one study from 2010 estimated that the average direct and indirect medical costs for patients with POAG are $1688 higher over a lifetime than other patients without this condition.” (opens the source at this quote in a new tab)
“For those with advanced disease, indirect costs such as costs for home health care and rehabilitation predominate.” (opens the source at this quote in a new tab)

Medicare Part D spending on prostaglandin analogs

“In 2013, Medicare spent $733 million on prostaglandin analogs; in 2017, this increased to $1.09 billion, with $943 million (86%) spent on branded prostaglandins and $148 million (14%) spent on generics.” (opens the source at this quote in a new tab)
“Median out-of-pocket cost of branded prostaglandins without generic equivalents was $35 (IQR = $29-$40) in 2009, $45 (IQR = $42-$101) in 2013, and $90 (IQR = $45-$159) in 2017.” (opens the source at this quote in a new tab)

Medicare Part D glaucoma medication spending per beneficiary, 2019 to 2023

“Median spending per beneficiary was $403.81 (interquartile range [IQR], $359.74-$444.73), and median spending per claim was $104.22 (IQR, $89.49-$118.41).” (opens the source at this quote in a new tab)
“Utilization intensity varied minimally across socioeconomic strata (claims per beneficiary, 3.8-4.0), and neither ADI nor income was consistently associated with brand spending or claims share.” (opens the source at this quote in a new tab)

Medicare reintervention and costs after incisional glaucoma surgery

“At 1 year, 15.1% of EX-PRESS shunt patients, 11.6% of tube shunt patients, and 8.8% of trabeculectomy patients had experienced failure based on postindex procedures. By 5 years follow-up, these rates were 31.5% of EX-PRESS shunt patients, 27.1% of tube shunt patients, and 23.5% of trabeculectomy patients. Five-year rates of glaucoma reoperations were 18.3%, 14.0%, and 15.1%, respectively.” (opens the source at this quote in a new tab)

Health care resource utilization: Medicare beneficiaries with glaucoma

“Among 78 526 participants with glaucoma, mean age was 79.1 years (standard deviation, 7.9 years), 60.9% were female, 78.4% were non-Hispanic White, and 13.8% met enrollment-based criteria for low-SES. Compared with White beneficiaries, Blacks had lower counts of outpatient visits (RR, 0.92; 95% confidence interval [CI], 0.90-0.93), visual field (VF) tests (RR, 0.92; 95% CI, 0.90-0.94), but more inpatient/ED encounters (RR, 2.42; 95% CI, 1.55-3.78) and surgeries (RR, 1.14; 95% CI, 1.03-1.27).” (opens the source at this quote in a new tab)

Burden increases with disease severity

“The economic burden of glaucoma is significant and increases as the disease worsens.” (opens the source at this quote in a new tab)

Direct and indirect costs: nationwide register study, Finland

“The annual additional total direct costs were EUR 2,660/glaucoma patient, EUR 1,769/glaucoma patient with medication, and EUR 3,979/operated glaucoma patient compared with persons without glaucoma. The respective additional total indirect costs were EUR 4,288, EUR 3,246, and EUR 12,902 per year.” (opens the source at this quote in a new tab)

Eye-related outpatient visits and procedure use by disease severity: United States commercial claims

“Patients with OAG appeared to have higher use of outpatient visits compared with patients with OHT only (mean, 4.2 visits [SD, 3.2 visits] vs. 3.0 visits [SD, 2.9 visits] per user, respectively). The mean number of eye-related outpatient visits increased with increasing baseline OAG severity (P < 0.0001).” (opens the source at this quote in a new tab)
“More patients in the OAG group had a physician office visit for a laser or surgical glaucoma procedure compared with patients in the OHT group (9.4% vs. 2.2%, respectively). The proportion of patients undergoing laser or surgical glaucoma procedures increased with increasing baseline OAG severity (P < 0.0001).” (opens the source at this quote in a new tab)

Adjusted drivers of annual eye-related outpatient costs: baseline severity and number of topical medication classes

“Costs increased with increasing baseline severity (from 30% to 129%) and number of TGM classes at baseline (from 8% to 68%; P < 0.0001 for both).” (opens the source at this quote in a new tab)

Documented disease worsening over 12 months and associated procedure rates

“Approximately 12% of the study population had a worsening in coded severity during the 12-month follow-up period” (opens the source at this quote in a new tab)
“Open-angle glaucoma surgery or procedure rates were substantial among patients with a worsening in coded severity, with the highest observed rates among OAG patients developing severe disease (52.1% and 47.0% of patients with a worsening in coded severity from moderate to severe and mild to severe, respectively).” (opens the source at this quote in a new tab)
“Treatment intensification also was observed in patients without a worsening in coded severity, ranging from 11.8% to 45.1% across baseline severity cohorts.” (opens the source at this quote in a new tab)

Aggregate United States direct medical costs and principal cost components

“Glaucoma is estimated to account for $US2.9 billion of direct medical costs among US adults annually.” (opens the source at this quote in a new tab)
“In general, they have shown that increased glaucoma severity correlates with increased costs, and medication and ophthalmologist examinations account for a majority of direct costs across studied North American and European regions.” (opens the source at this quote in a new tab)

Cost components in end-stage glaucoma with visual rehabilitation care

“In a retrospective evaluation of resource use and costs for patients with end-stage glaucoma who were receiving visual rehabilitation care, three US centres provided 81 patient records indicating patient level billing and reimbursement for eye care visits, medications, procedures and specialized low vision and glaucoma-related services.” (opens the source at this quote in a new tab)
“Visual rehabilitation services included low vision devices, assessment of daily functioning, orientation and mobility training and counselling.” (opens the source at this quote in a new tab)
“Total costs for 2 years were determined to comprise 15% for visual rehabilitation, 37% for ophthalmology care and 48% for pharmaceuticals.” (opens the source at this quote in a new tab)