Drugs & Aging

, Volume 22, Issue 4, pp 315–321 | Cite as

The Economic Burden of Glaucoma and Ocular Hypertension

Implications for Patient Management: A Review
  • Jean-François Rouland
  • Gilles Berdeaux
  • Antoine Lafuma
Review Article

Abstract

This paper reviews the burden and economic consequences of glaucoma upon healthcare systems and patients, especially elderly patients. An extensive review of the literature was conducted, primarily using MEDLINE, but also by examining selected article reference lists, relevant websites and the proceedings of specialised conferences. All relevant articles and documents were analysed.

Glaucoma is characterised by destruction of the optic nerve. It is most often a continuous, chronic eye disease and the most frequent diagnosis is primary open angle glaucoma (POAG). POAG is mostly associated with intraocular hypertension which can be delayed by medication, surgery or laser therapy.

The prevalence rate of glaucoma is about 1% in the population >50 years of age. The rate increases with age and is higher in Black and Hispanic populations. Glaucoma affects more than 67 million people worldwide. Cost-of-illness studies have shown the importance of this disease, on which more than £300 million was spent in the UK in 2002. Most of the costs (45%) were associated with direct medical costs, but direct nonmedical costs (20%) and indirect costs (35%) were also not negligible. Recent economic studies have shown a dramatic increase in the number of patients with glaucoma receiving treatment but a reduction in use of surgical procedures to treat the condition, especially as first-line therapy. The greater part of medical expenditure is now on medication, with new, more potent, better tolerated, but more costly drugs replacing older and less expensive medications. Treatment costs are directly related to the severity of disease and the number of different treatments used; they are also negatively correlated with treatment efficacy in reducing intraocular pressure. However, long-term economic benefits that may be associated with use of more potent new drugs (by delaying institutionalisation) have never been documented. Glaucoma screening has also been found not to be cost effective, although these results should be reconsidered in the light of new data.

Keywords

Glaucoma Latanoprost Ocular Hypertension Bimatoprost Visual Field Loss 

Notes

Acknowledgements

This work was supported by a grant from Alcon Laboratories. The authors have no conflicts of interest that are directly relevant to the content of this study.

References

  1. 1.
    Reidy A, Minassian DC, Vafidis G, et al. Prevalence of serious eye disease and visual impairment in a north London population: population based, cross sectional study. BMJ 1998; 316: 1643–6PubMedCrossRefGoogle Scholar
  2. 2.
    The Royal College of Ophthalmologists. A national research strategy for ophthalmology [online]. Available from URL: http://www.rcophth.ac.uk/scientific/docs/EyeR-esearchFinal.pdf [Accessed 2004 Oct 20]
  3. 3.
    Quigley HA. Number of people with glaucoma worldwide. Br J Ophthalmol 1996 may; 80(5): 389–93PubMedCrossRefGoogle Scholar
  4. 4.
    Prevent Blindness America. Vision problems in the US [online]. Available from URL: http://www.preventblindness.org/vpus/VPUS_report_web.pdf [Accessed 2004 Oct 20]
  5. 5.
    Minassian DC, Reidy A, Coffey M, et al. Utility of predictive equations for estimating the prevalence and incidence of primary open angle glaucoma in the UK. Br J Ophthalmol 2000; 84(10): 1159–61PubMedCrossRefGoogle Scholar
  6. 6.
    Evans J. Causes of blindness and partial sight in England and Wales 1990–1991. London: HMSO, 1995Google Scholar
  7. 7.
    Tuck MW, Crick RP. The projected increase in glaucoma due to an ageing population. Ophthalmic Physiol Opt 2003 mar; 23(2): 175–9PubMedCrossRefGoogle Scholar
  8. 8.
    Stephenson JR. Wellcome Trust support for vision research. Br J Ophthalmol 1999; 83: 890–1PubMedCrossRefGoogle Scholar
  9. 9.
    Coyle D, Drummond M. The economic burden of glaucoma in the UK: the need for a far-sighted policy. Pharmacoeconomics 1995 jun; 7(6): 484–9PubMedCrossRefGoogle Scholar
  10. 10.
    Jonsson B, Kriedlstein. Primary open-angle glaucoma: differences in international treatment patterns and costs. Oxford: Isis Medical Media, 1999Google Scholar
  11. 11.
    Rouland JF, Peigne G, Sellem E, et al. An observational, retrospective two-year cost study in primary open-angle glaucoma and ocular hypertension in newly diagnosed patients [in French]. J Fr Ophthalmol 2001 mar; 24(3): 233–43Google Scholar
  12. 12.
    Oostenbrink JB, Rutten-van Molken MP, Sluyter-Opdenoordt TS. Resource use and costs of patients with glaucoma or ocular hypertension: a one-year study based on retrospective chart review in the Netherlands. J Glaucoma 2001 jun; 10(3): 184–91PubMedCrossRefGoogle Scholar
  13. 13.
    Kobelt G. Health economics, economic evaluation, and glaucoma. J Glaucoma 2002; 11(6): 531–9PubMedCrossRefGoogle Scholar
  14. 14.
    Minassian DC, Reidy A. Visual impairment from cataract in England and Wales: the NHS surgical burden. CE Optometry 2001; 4(2): 52–4Google Scholar
  15. 15.
    Fiscella RG, Geller JL, Gryz LL, et al. Cost considerations of medical therapy for glaucoma. Am J Ophthalmol 1999 oct; 128(4): 426–33PubMedCrossRefGoogle Scholar
  16. 16.
    Fiscella RG, Green A, Patuszynski DH, et al. Medical therapy cost considerations for glaucoma. Am J Ophthalmol 2003 jul; 136(1): 18–25PubMedCrossRefGoogle Scholar
  17. 17.
    Vold SD, Riggs WL, Jackimiec J. Cost analysis of glaucoma medications: a 3-year review. J Glaucoma 2002 aug; 11(4): 354–8PubMedCrossRefGoogle Scholar
  18. 18.
    Green J, Siddall H, Murdoch I. Learning to live with glaucoma: a qualitative study of diagnosis and the impact of sight loss. Soc Sci Med 2002 jul; 55(2): 257–67PubMedCrossRefGoogle Scholar
  19. 19.
    AGIS Investigators. Advanced Glaucoma Intervention Study (AGIS) 4: comparison of treatment outcomes within race — 7 yr results. Ophthalmology 1998; 105: 1146–64CrossRefGoogle Scholar
  20. 20.
    Gordon MO, Beiser JA, Brandt JD, et al. The ocular hypertension treatment study: baseline factors that predict the onset of primary open-angle glaucoma. Arch Ophthalmol 2002 jun; 120(6): 714–20PubMedCrossRefGoogle Scholar
  21. 21.
    Feiner L, Piltz-Seymour J. Collaborative initial glaucoma treatment study: a summary of results to date. Curr Opin Ophthalmol 2003; 14: 106–11PubMedCrossRefGoogle Scholar
  22. 22.
    Baudouin C, Rouland JF, Le Pen C. Changes in medical and surgical treatments of glaucoma between 1997 and 2000 in France. Eur J Ophthalmol 2003 Jul; 13Suppl. 4: S53–60PubMedGoogle Scholar
  23. 23.
    Bateman DN, Clark R, Azuara-Blanco A, et al. The effects of new topical treatments on management of glaucoma in Scotland: an examination of ophthalmological health care. Br J Ophthalmol 2002 may; 86(5): 551–4PubMedCrossRefGoogle Scholar
  24. 24.
    National Prescribing Centre. Recent developments in primary open angle glaucoma and ocular hypertension. MeReC Bulletin 2003; 13(5): 17–20Google Scholar
  25. 25.
    Jampel HD, Schwartz GF, Robin AL, et al. Patient preferences for eye drop characteristics: a willingness-to-pay analysis. Arch Ophthalmol 2003 apr; 121(4): 540–6PubMedCrossRefGoogle Scholar
  26. 26.
    Serie J, Cantor L, Gross R, et al. Best practice treatment algorithm for primary open-angle glaucoma: implications for US ophthalmology practice. Manag Care Interface 2002 jul; 15(7): 37–48Google Scholar
  27. 27.
    Netland PA, Landry T, Sullivan EK. et al., on behalf of Travoprost Study Group. Travoprost compared with latanoprost and timolol in patients with open-angle glaucoma or ocular hypertension. Am J Ophthalmol 2001 oct; 132(4): 472–84PubMedCrossRefGoogle Scholar
  28. 28.
    Halpern MT, Covert DW, Robin AL. Projected impact of travoprost versus both timolol and latanoprost on visual field deficit progression and costs among black glaucoma subjects. Trans Am Ophthalmol Soc 2002; 100: 109–17PubMedGoogle Scholar
  29. 29.
    Cohen JS, Gross RL, Cheetham JK, et al. Two-year double-masked comparison of bimatoprost with timolol in patients with glaucoma or ocular hypertension. Surv Ophthalmol 2004 Mar; 49Suppl. 1: S45–52PubMedCrossRefGoogle Scholar
  30. 30.
    Nordmann JP, Le Pen C, Lilliu H, et al. Estimating the long term visual field consequences of average daily intraocular pressure and variance. Clin Drug Invest 2003; 23(7): 431–8CrossRefGoogle Scholar
  31. 31.
    Dubiner HB, Sircy MD, Landry T, et al. Comparison of the diurnal ocular hypotensive efficacy of travoprost and latanoprost over a 44-hour period in patients with elevated intraocular pressure. Clin Ther 2004 jan; 26(1): 84–91PubMedCrossRefGoogle Scholar
  32. 32.
    Rouland JF, Le Pen C, Gouveia Pinto C, et al. Cost-minimisation study of dorzolamide versus brinzolamide in the treatment of ocular hypertension and primary open-angle glaucoma: in four European countries. Pharmacoeconomics 2003; 21(3): 201–13PubMedCrossRefGoogle Scholar
  33. 33.
    Nordmann JP, Auzanneau N, Ricard S, et al. Vision related quality of life and topical glaucoma treatment side effects. Health Qual Life Outcomes 2003 Dec 10; 1(1): 75–6PubMedCrossRefGoogle Scholar
  34. 34.
    Deschaseaux-Voinet C, Lafuma A, Berdeaux G. Cost and effectiveness of brinzolamide versus dorzolamide in current practice: an analysis based on the UK-GPRD data base. J Med Econ 2003; 6: 69–78CrossRefGoogle Scholar
  35. 35.
    Jackson C, Hirst L. Brisbane GPs’ perceptions of screening for primary open-angle glaucoma. Aust N Z J Ophthalmol 1995 aug; 23(3): 179–81PubMedCrossRefGoogle Scholar
  36. 36.
    Boivin JF, McGregor M, Archer C. Cost effectiveness of screening for primary open angle glaucoma. J Med Screen 1996; 3(3): 154–63PubMedGoogle Scholar
  37. 37.
    Tuck MW, Crick RP. The cost-effectiveness of various modes of screening for primary open angle glaucoma. Ophthalmic Epidemiol 1997 mar; 4(1): 3–17PubMedCrossRefGoogle Scholar
  38. 38.
    Michelson G, Groh MJ. Screening models for glaucoma. Curr Opin Ophthalmol 2001 apr; 12(2): 105–11PubMedCrossRefGoogle Scholar
  39. 39.
    Ainsworth JR, Jay JL. Cost analysis of early trabeculectomy versus conventional management in primary open angle glaucoma. Eye 1991; 5(Pt 3): 322–8PubMedCrossRefGoogle Scholar
  40. 40.
    Calissendorff BM. Costs of medical and surgical treatment of glaucoma. Acta Ophthalmol Scand 2001 jun; 79(3): 286–8PubMedCrossRefGoogle Scholar
  41. 41.
    Calissendorff BM. Consumption of glaucoma medication. Acta Ophthalmol Scand 2001 feb; 79(1): 2–5PubMedCrossRefGoogle Scholar
  42. 42.
    Lafuma A, Voinet C, Berdeaux G. Treatment duration as a cost driver of glaucoma care: a life-long societal perspective in France, Germany and the Netherlands. Value in Health 2003; 6(6): 639–40CrossRefGoogle Scholar
  43. 43.
    Brezin AP, Lafuma A, Fagnani F, et al. Blindness, low vision, and other handicaps as risk factors attached to institutional residence. Br J Ophthalmol 2004 oct; 88(10): 1330–7PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2005

Authors and Affiliations

  • Jean-François Rouland
    • 1
  • Gilles Berdeaux
    • 2
  • Antoine Lafuma
    • 3
  1. 1.Service d’OphtalmologieHôpital Claude HuriezLilleFrance
  2. 2.Université de Bretagne SudVannesFrance
  3. 3.CEMKA EVALBourg la ReineFrance

Personalised recommendations