Glaucoma linked to high individual, societal costs
Key takeaways:
- People with vs. without glaucoma had direct costs that were 2,660 euros higher annually.
- Among people aged younger than 64 years, those with glaucoma also had higher rates of premature retirement.
Glaucoma appeared tied to significant costs not only for individuals, but also for society as a result of premature retirement and loss of productivity, according to a study conducted in Finland and published in PLOS One.
“Even though timely and effective treatment could prevent the deterioration of vision, glaucoma remains as one of the leading causes of blindness worldwide,” Petri K. M. Purola, MSc, a PhD candidate in the department of ophthalmology at Tampere University in Finland, and colleagues wrote. “Furthermore, the low public awareness, the asymptomatic early stages of glaucoma and the nonadherence to prescribed therapy can lead to inadequate control of glaucoma, with severe consequences for both the individual and the society.”
Purola and colleagues evaluated data from the Health 2000 survey conducted from 2000 to 2001 by the Finnish Institute for Health and Welfare and followed up with participants from 1999 to 2011.
The researchers compared medical costs, calculated at 2019 euro rates, for people with vs. without glaucoma, further comparing between those receiving medication and surgical glaucoma treatment as well. They categorized costs as direct costs — including hospitalizations, outpatient visits and travel costs — and indirect costs related to premature retirement and lost productivity due to glaucoma.
The study included 192 participants with glaucoma (71% women; mean age, 74 years) and 6,952 people without glaucoma (54% women; mean age, 53 years). Of those with glaucoma, 141 received medication only, 59 received surgery and 31 had no documented treatment. Thirty-nine participants were treated with medication and surgery.
Those with glaucoma had significantly more eye-related and non-eye-related hospitalizations and outpatient visits than those without glaucoma after adjusting for age and sex (P < .001), and people with glaucoma spent significantly more time annually in the hospital than people without glaucoma (P < .001).
All treatment groups of with glaucoma had significantly higher mean direct costs annually compared with those without glaucoma (P < .001), including overall (by 2,660 euros), and for those who received surgery (by 3,979 euros) or medication (by 1,769 euros).
Of all Finnish people with glaucoma, annual health care costs were 202 million euros higher than would be expected for people without glaucoma, representing 0.86% of the total of Finland’s health care costs. Medication was associated with a higher cost of 100 million euros, and surgery was associated with a higher cost of 92 million euros. Most of these additional costs were due to non-eye-related hospitalizations, the researchers wrote.
Premature retirement was much more common among people aged 30 to 64 years with glaucoma than people without glaucoma (85.3% vs. 29.8%) and was associated with a higher annual mean cost per person (194,823 euros vs. 154,185 euros).
The mean indirect cost of premature retirement and productivity loss was highest among people who received glaucoma surgery (950,941 euros annually), followed by all people with glaucoma (670,118 euros), people who received medication only (636,145 euros) and people without glaucoma (530,336 euros).
“Here we show that glaucoma is associated with a high economic burden on the society,” the researchers wrote. “The major proportion of the costs is not directly caused by treatment of glaucoma, but rather the increased use of non-eye-related health services as well as loss of productivity. In addition, different treatment options for glaucoma show noticeable differences in costs and resource use.”
Perspective
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World Glaucoma Week, a global initiative designed to raise glaucoma awareness, was celebrated March 10-16. Through increasing public awareness, the initiative’s hope is that more individuals will seek regular examinations, yielding earlier disease detection and subsequent prevention of unnecessary loss of function and quality of life.
The work of Purola and colleagues coincides nicely with World Glaucoma Week, as it provides perspective of both direct and indirect costs of glaucoma diagnosis and care on a national level in Finland. This study found that glaucoma constitutes a major economic burden for the Finnish health care system and society. This is consistent with past research on the burden respective national health care systems and societies face as they combat glaucoma.
What was intriguing about this study was that the majority of the direct health care costs in patients with glaucoma actually came from non-eye-related services, which included a significantly greater amount of time glaucoma patients spent hospitalized compared with their non-glaucoma peers. They reasonably attributed this to the irreversible vision loss occurring in glaucoma, specifically in severe cases in which the risk for falls, injuries and accidents rises disproportionately compared with those without vision-related disabilities.
The link between this study and World Glaucoma Week is serendipitous, as it underscores the necessity of early detection. It also should apply pressure on all of us to raise public awareness to ultimately reduce disease burden on patients and at systemic and societal levels.
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