Glaucoma care costs rising, but moderately

Seattle-The cost of caring for patients with glaucoma has risen in the past decade, but at a lower rate than that of general or medical inflation. For Medicare beneficiaries, the greatest expense was not the treatment for glaucoma per se, but rather for cataracts and retinal eye care, said Harry Quigley, MD.

Treatment for cataracts and retinal eye care substantially exceeded the cost of glaucoma care, and expenses for office visits represented the largest category of costs.

“The cost of non-glaucoma eye care was 67% higher than glaucoma care in 2009,” said Dr. Quigley, of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore.

Dr. Quigley and colleagues used billing data from Medicare to estimate the cost of glaucoma care for beneficiaries, from 2002 to 2009.

“Overall glaucoma payments were $37.4 million for the 5% sample that we used,” Dr. Quigley said. “This amounts to an estimated cost of $748.4 million, or 0.4% of all Medicare payments.”

Office visits amounted to almost half of all glaucoma-related costs, diagnostic testing was about one-third, and surgical and laser procedures added to about 10% of costs each. The majority of glaucoma-related costs (87.5%) were for patients with either open-angle glaucoma (OAG) or suspected open angle.

Few patients with OAG (<3%) were estimated to have undergone surgery, while about 5% were treated with laser trabeculoplasty in 2009. Among those with angle-closure glaucoma, the largest cost was for laser iridotomy (35% of their total).

Added to the cost of treatment were out-of-pocket costs that the patient had to pay, depending on the type of Medicare program that the patient was enrolled in.

“Add a 20% deductible to payment, or other costs, and that $748 million goes up to $1.4 billion,” Dr. Quigley said.

During the study period, the cost of glaucoma care went up by 30% and the cost-per-person, per year rose from $197 to $228. These increases were driven primarily by increased reimbursement for visits, an increased number of OAG suspects, more higher-level visits, and more laser and surgical procedures.

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