Longitudinal Trends in Resource Utilization Associated with Newly Diagnosed Primary Angle Closure Glaucoma in the United States.

Abstract

Prcis: Average cumulative two-year cost following first primary angle closure glaucoma diagnosis was $2,960. Elderly and Black patients were at higher risk of being among the costliest 5% (>$9,813) of cases, accounting for 21.3% of costs.

Purpose: To assess longitudinal eye care costs associated with newly diagnosed primary angle closure glaucoma (PACG) in the United States.

Methods: Patients with a diagnosis of PACG between 2009 to 2017 were identified in Optum's de-identified Clinformatics® Data Mart Database based on International Classification of Diseases (ICD) codes. Newly diagnosed PACG was defined as: 1) diagnosis by an ophthalmologist or optometrist; 2) observable for at least 12 months before and 24 months after index diagnosis; 3) no prior history of glaucoma treatment; 4) PACG-related treatment initiated after index diagnosis. Logistic regression modeling was performed to identify risk factors for being in the top 5% of cumulative two-year costs.

Results: Among 12,673 eligible patients, the average cumulative two-year cost following first PACG diagnosis was $2,960. Patient costs were highest in the six months immediately following diagnosis, accounting for 52.3% of all two-year costs. 56.7% of all two-year costs were related to treatment procedures. The costliest 5% (>$9,813) of patients accounted for 21.3% of all two-year PACG-related costs. Risk factors for being in costliest 5% (P<0.05) included older age, Black race, PPO or other Medicare insurance product, living in the Midwest or the South, and recent diagnosis of anatomical narrow angles (ANA).

Conclusion: Costs associated with newly diagnosed PACG were found to be disproportionately driven by a small subset of cases. Elderly and Black patients were more likely to be within the top 5% of cumulative two-year costs. Identifying and preventing the costliest PACG cases could reduce PACG-related eye care expenditures.