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Costs in ophthalmology: A review of recent studies
Researchers focused on costs in the fields of glaucoma, cataract and retina.
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It is well known that medical costs are rising worldwide, mainly due to the growing number of patients and the improvements in diagnostic and therapeutic options.
The patients themselves are another important influencing factor that should not be underestimated. Patients nowadays get more information about their disease via the internet and social media, and their demands concerning medical care are increasing.
Methods
In an earlier review, we focused on increasing health care costs and factors that may influence the costs of glaucoma care. We concluded that the ideal study design that would let us optimize glaucoma treatment to make it more cost-effective still needs to be designed.
This review focuses not only on studies in the field of glaucoma, but also studies in the fields of cataract and retinal diseases.
Looking at approximately 100 studies about costs in certain fields of ophthalmology (glaucoma, cataract and retina), it is interesting to acknowledge the diversity of topics discussed in these papers.
Four main topics were selected: general aspects about costs in ophthalmology; costs in cataract surgery; costs in the field of glaucoma; and costs in the field of retinal diseases.
Results and discussion
Most of the 100 studies examined looked at costs in the context of cataract and cataract surgery, followed by studies in the fields of glaucoma and retina.
It is interesting to see the difficulties in collecting data in the different countries and to realize the difficulties in finding the most appropriate way of designing matching studies.
In Switzerland, for example, there is no central database with data about diagnostic procedures, number of operations or even numbers of patients affected by a disease.
The largest database available is the Medicare database in the United States, followed by well-structured databases in the United Kingdom and Scandinavian countries. Only a few studies come from central and southern Europe. Interesting data are found in studies about costs in Africa, where, for example, the costs for glaucoma medications may exceed the monthly income of a patient.
The question arises: What is the best way to look at costs and compare different procedures? Studies about cost utility are more precise than cost-effectiveness analyses, but cost utility study design is more challenging.
When investigating the different types of studies, we found that they mostly compare the direct costs of different treatments (for example, one glaucoma drug vs. another drug, or one type of operation vs. another type). Unfortunately, the indirect costs are seldom included in these studies, and therefore the real financial burden for the patient is not correctly represented.
Most of the studies about costs are in the field of cataract and can be divided into three categories:
- Comparisons of costs of cataract surgery in different regions of the world;
- Comparisons of the different surgical techniques (for example, standard phacoemulsification vs. femtosecond laser-assisted techniques, or the use of different IOLs); and
- Interactions between cataract surgery and other ophthalmic diseases, especially retinal diseases and glaucoma.
An interesting study from Nigeria highlights the costs for the patient in an economically constrained environment. The direct costs of a cataract operation represent at least 50 days of daily income for 70% of the population, and the value of indirect costs is as high as the value of direct costs.
Changing costs are highlighted in a study by Brown and colleagues in 2012. They showed that the quality of life improved after cataract surgery and that the price of the cataract operation in 2012 was 34.4% lower than in 2000 and 85% lower than in 1985.
In glaucoma, studies mainly compare the different treatment modalities (medical vs. laser and surgery). One interesting study found that we can increase cost-effectiveness by adapting the treatment strategies to glaucoma severity.
As mentioned, medical costs are generally rising. However, there is one exception to this rule. One U.S. study with data from Medicare patients showed that the costs for glaucoma actually decreased from 2002 to 2009, while on the other hand the costs for comorbidities in glaucoma patients (cataract and retinal diseases) were rising.
In the third field, retina, research interests focused on retinal surgery, complications of diabetes and therapy for age-related macular degeneration.
An interesting study from New Zealand compared the outcome of retinal detachment repair with the income of the patient. The researchers found that patients of lower socioeconomic background had more delays until they got the primary treatment, but the type of retinal detachment and the final outcome did not differ.
It is important to keep in mind that the quality of life of patients with AMD is reduced not only by the diagnosis of threatening blindness, but also by the time investment and costs of the chronic, practically never-ending therapy.
In summary, looking at recent studies of costs in the specific fields of cataract, glaucoma and retina, it is interesting to see that, first, there are not many studies altogether; second, it is difficult to find an appropriate way of designing these studies; and third, it is difficult to compare the results in different countries.
It would be important to implement more national central databases to get better access to data.
- References:
- Adio AO, et al. Clin Ophthalmol. 2012;doi:10.2147/OPTH.S37145.
- Allbon DS, et al. N Z Med J. 2015;128(1427):18-24.
- Brown GC, et al. Ophthalmology. 2013;doi:10.1016/j.ophtha.2013.04.030.
- Guedes RA, et al. Medicine (Baltimore). 2016;doi:10.1097/MD.0000000000005745.
- Ibrahim N, et al. BMC Health Serv Res. 2015;doi:10.1186/s12913-015-0831-2.
- Quigley HA, et al. Ophthalmology. 2013;doi:10.1016/j.ophtha.2013.04.027.
- Töteberg-Harms M, et al. Curr Opin Ophthalmol. 2017;doi:10.1097/ICU.0000000000000343.
- For more information:
- Frances Meier-Gibbons, MD, can be reached at Eye Center Rapperswil, Merkurstr. 50, CH-8640 Rapperswil, Switzerland; email: frances.meier@bluewin.ch.
Disclosure: Meier-Gibbons reports she is a consultant and/or lectures for Alcon, Allergan, Novartis and Santen.