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Laser trabeculoplasty may not provide glaucoma-specific cost savings
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Laser trabeculoplasty did not reduce reliance on glaucoma medications or costs associated with glaucoma treatment, according to a study.
The retrospective administrative claims analysis involved medical and pharmacy claims data from 4,743 patients with open-angle glaucoma who underwent trabeculoplasty and 16,484 patients with open-angle glaucoma who used medications. Patients were followed for 12 months before their specific index date and 24 months after the index date.
Younger age (P < .001), low medication adherence (P = .001), high comorbidities (P = .006) and geographic region (P < .001) were significantly associated with receiving laser trabeculoplasty.
In the trabeculoplasty cohort, 60% of patients did not have a pharmacy claim at 45 days after the index date; this decreased to 20% at 2 years.
Per-patient glaucoma-specific medical costs were $2,684 in the trabeculoplasty group and $1,980 in the medication group (P < .0001). Per-patient glaucoma-specific pharmacy costs were $807 in the trabeculoplasty group and $1,467 in the medication group (P < .0001). Per-patient overall glaucoma-specific costs were $3,441 in the trabeculoplasty group and $3,408 in the medication group; the between-group difference was not significant.
“Although fewer topical [open-angle glaucoma] medications are used after treatment with [laser trabeculoplasty], the majority of patients (80%) require supplementary treatment with topical drops within 2 years,” the study authors said. “Therefore, [laser trabeculoplasty] may not be advantageous in resolving poor medication adherence.” – by Matt Hasson
Disclosure: Schultz reports he was an employee of Allergan at the time of the study. See the study for all other authors’ relevant financial disclosures.
Perspective
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Derek MacDonald, OD, FAAO
Nearly 40 years ago Wise and Witter noted that argon laser trabeculoplasty resulted in “… a substantial, long-lasting reduction of intraocular pressure …,” and in 1995 the Glaucoma Laser Trial concluded that “initial treatment with (ALT) was at least as efficacious as initial treatment with topical medication.”
In the late 1990s, selective laser trabeculoplasty (SLT) proved to be a safe and effective initial therapy that was as efficacious as latanoprost. Investigators found that SLT could be applied as primary or adjunctive therapy, and that repeat SLT has similar efficacy as primary SLT. In an era of evidence-based medicine, laser trabeculoplasty (LT) justifiably assumed a prominent role, but is this position defensible in an increasingly cost-based world?
For patients on prostaglandin analog monotherapy, Schultz and colleagues conclude that adjunct LT provides no cost savings and does not completely eliminate the need for additional topical therapy. However, only one in four patients receiving LT required two or more medications versus nearly 90% of those in the medication-only cohort. Adherence decreases and preservative exposure increases with treatment complexity; the impact of multiple medications cannot be understated.
Given that SLT may be more effective in early to moderate glaucoma and “… offers a modest potential cost saving over primary medical therapy…,” SLT appears to have both evidence- and cost-based support for an ongoing role in the management of OAG.
Reference:
Glaucoma Laser Trial Research Group. Am J Ophthalmol. 1995;120(6):718-731.
Wise JB, et al. Arch Ophthalmol. 1979;97(2):319-322.
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