Glaucoma: an economic time bomb


The significant relationship [between cost and stage of disease] demonstrates the important economic repercussions in health care systems world wide, if glaucoma is not dealt with quickly

As the percentage of the world's ageing population increases, so too does the number of glaucoma patients and yet there is no global programme in place to tackle the problem. One issue, that is perhaps standing in the way of progress, is that glaucoma is generally difficult to diagnose until the later stages and since, in many parts of the world, it is not part of basic eye screening programmes, many cases still go undiagnosed. For example, statistics for the US, Australia and Europe show that the disease is detected in only half of patients. This can largely be attributed to the fact that glaucoma is generally asymptomatic or it exhibits non-specific symptoms up to the late stages, this, coupled with the fact that glaucoma screening is not part of the standard healthcare protocol in many parts of the world, means the condition often goes undiagnosed. It is clear that something needs to be done to address the rise of the disease since it could have serious economic repercussions as the ageing population continues to increase.

What's the cost?

In a multicentre, international European study, the records of 194 patients with glaucoma from a total of 1,655 consecutive charts were selected and cases stratified according to disease severity. Selection of patients was based on the diagnoses of primary open-angle glaucoma, the suspicion of glaucoma, ocular hypertension and normal tension glaucoma. Patients were followed up for a minimum of five years.

Investigators assessed glaucoma severity using a six-stage system based on static threshold visual field parameters. Resource utilization was abstracted from the charts and the unit costs were applied to the estimated direct costs to the payer. (Resources include outpatient visits, glaucoma surgeries and medications.) Professor Traverso then calculated the resource utilization and estimated direct cost of the treatment per patient, per year.

The results showed that, as the severity of the glaucoma increases, so did the cost. The direct cost of treatment increased by an estimated €86 for each incremental step, ranging from €455 per patient per year for stage zero, to €969 per patient per year for stage four of the disease. The cost of medication for each person accounted for between 42% - 56% of the total direct cost for all stages of the disease.

What does this mean?

This significant relationship demonstrates the important economic repercussions in health care systems world wide, if glaucoma is not dealt with quickly. While glaucoma cannot be prevented or cured, the disease can be slowed, and in some cases halted. Through early detection of the disease and by delaying its progression to the later stages we can greatly affect the quality of vision and the quality of life in millions of patients. In addition, we could also significantly alleviate the potential economic burden, resulting from ageing populations. All this could be achieved by putting in place simple monitoring programmes.

Professor Traverso commented, "Ophthalmologists, general practitioners and health administrators now have a European based set of data demonstrating that managing glaucoma effectively and by preventing progression beyond the early to moderate stages of the disease, will result in a decrease in direct costs. This should be used to offset the constraints on resource delivery to manage patients with an unquestionable diagnosis of progressive glaucoma."

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