This article is more than 5 years old. Information may no longer be current.
Glaucoma detection program carries low costs in Philadelphia
Click Here to Manage Email Alerts
Researchers assessed the costs of a glaucoma detection program in Philadelphia community centers and found that on a per-patient basis, examination costs were low, although opportunities exist to improve efficiency, according to a study from the British Journal of Ophthalmology.
“In the U.S., an estimated $623 is spent per patient per year when glaucoma is in its early stages, but considerably more, at $2,511 per patient per year, when glaucoma is advanced,” according to Laura T. Pizzi, PharmD, MPH, and fellow researchers.
Of 1,649 participants across 43 sites within the Philadelphia Glaucoma Detection and Treatment Project (PGDTP), mean total per-participant examination time was 56 minutes, and mean patient age was 69 years.
PGDTP program sites are in areas with high rates of poverty, and lower income, older minority populations are at a higher risk for glaucoma and are often underserved in eye care, they wrote.
The examinations included a six-step process: check-in, participant consent and medical history; visual acuity, autorefraction, pupil check, measurement of central corneal thickness; fundus photo; visual field exam; ophthalmologist assessment; and check-out and satisfaction survey.
The population was 68% female, 70% were Black, and 545 (33%) were newly identified as having a glaucoma-related diagnosis.
The mean total examination cost/participant was $139.
Newly identified glaucoma cost/case was $420, and cost/case for any ocular disease identified was $273, according to the researchers.
There were 64 open-angle glaucoma and angle-closure glaucoma diagnoses and 151 angle-closure diagnoses.
A total of 293 cases of non-glaucomatous disease was detected.
The total cost for examinations without dilation was $64,680 ($40.45/participant).
The visual field test and the ophthalmologist step were the costliest exam steps, at $5.00 and $22.77, respectively.
For those receiving dilation, there was an additional average cost of $6.31.
The total examination cost for all participants (including both dilated and nondilated) was $67,018 ($41.00/participant).
The researchers determined that the detection rates were comparable with prior screening programs that focused on high-risk populations.
Researchers found a high number of narrow-angle cases and attribute this to participants coming from an underserved population with a higher prevalence of cataracts.
“Findings are important because detection and treatment can delay glaucoma progression and its associated costs,” researchers wrote.
The authors said they hope the findings can be used to identify opportunities to increase PGDTP efficiency and those within other community-based glaucoma detection programs.
“There is very little research on the implementation costs of glaucoma community-based examination,” Pizzi said in an interview with Primary Care Optometry News. “This paper addresses this void and will inform other institutions seeking to operationalize such programs.” – by Abigail Sutton
Disclosure: Pizzi reports no relevant financial disclosures. Please see the full study for remaining authors’ disclosures.
Perspective
Back to Top
Carl H. Jacobsen, OD, FAAO
The public health impact of glaucoma can’t be denied. Worldwide, this disease is a leading cause of irreversible blindness. In this country, 2.7 million people over age 40 have glaucoma, and 50% of glaucoma cases are estimated to be undiagnosed. This is a significant public health problem with a tangible effect on the lives of so many.
It is well established that earlier diagnosis leads to better outcomes at a fraction of the cost. Why are so many glaucoma patients undiagnosed? Here’s a clue: it’s not due to your failure to upgrade to the latest generation SD-OCT. Yes, glaucoma can be difficult to diagnose, but in the big picture, access to health care is the elephant in the room.
Pizzi and colleagues examined a community-based glaucoma detection program and found a significant, low-cost health benefit for hard-to-reach, at-risk communities.
In my practice, the patients with advanced disease at the point of diagnosis are a significant management challenge, often with poor outcomes. While community-based screening programs are no substitute for high-quality, personalized health and eye care, they serve a stop-gap function with true benefits.
Perhaps I’ll skip that latest software upgrade and volunteer in my local free clinic.
Click Here to Manage Email Alerts