Table 3.
Glaucoma treatment costs
| Reference | Study | Time horizon | Country | Costs reported | Cost | Currency | Cost year | GBP (2016) | Disaggregation |
|---|---|---|---|---|---|---|---|---|---|
| Tan and Au [45] | Prospective uncontrolled interventional case-series of iStent implantation in combination with cataract surgery for glaucoma patients | 3 years | UK | All patients 3 years, cost of iStent plus drops (branded) | £36,598.02 | GBP | Not stated | N/A | Cost calculations included cost of iStent implantation (incl. disposables, viscoelastic materials; excl. reusable instruments, surgeon time, theater time) and of drops in the two treatment strategies |
| All patients 3 years, cost of iStent plus drops (generic) | £31,893.12 | GBP | Not stated | N/A | As above | ||||
| All patients 3 years—drops (branded) | £12,812.10 | GBP | Not stated | N/A | As above | ||||
| All patients 3 years—drops (generic) | £8107.20 | GBP | Not stated | N/A | As above | ||||
| Kaplan et al. [62] | Markov cohort model, hypothetical cohort of 100,000 patients requiring glaucoma surgery, managed medically, with trabeculectomy or with Baerveldt implant (latter not shown) | 5 years | USA | Medication mean total cost | $6172.00 | USD | 2013 | £4036.32 | Total costs were not disaggregated; however, unit costs reported for surgeon, facility, office visit, Humphrey visual field, optical coherence tomography, bleb leak (multiple items), diplopia (multiple items) |
| Trabeculectomy mean total cost | $7872.00 | USD | 2013 | £5148.08 | |||||
| Yep et al. [88] | Claims database analysis to estimate the pre/post index diagnosis cost of care for 8575 glaucoma patients | 1 year | USA | Mean annual total direct glaucoma-specific costs per patient—before diagnosis | $107.00 | USD | Not stated | N/A | Costs not disaggregated but based on inpatient stays, emergency department visits, general and vision-related office visits, glaucoma diagnostic tests, glaucoma surgeries, and medications |
| Mean annual total direct glaucoma-specific costs per patient—after diagnosis | $487.00 | USD | Not stated | N/A | |||||
| Iordanous et al. [58] | Direct cost projection of glaucoma treatment with trabectome, iStent, and endoscopic cytophotocoagulation | 6 years | Canada | Cost of stent materials per patient—iStent | $1044.00 | CAD | Not stated | N/A | Based only on cost of device obtained from local distributors (2× iStent, total CA$1000), plus cost of disposable materials during surgery (CA$44). Surgeon’s fees were not included, and no follow-up health care utilization was included |
| Olsen et al. [59] | Danish National Register cross-sectional study of 27,380 new glaucoma/ocular hypertension patients | 5.5 years | Denmark | Total mean annual direct glaucoma-specific health care costs of “average patient” | €369.00 | EUR | 2007 | £291.69 | Not disaggregated but includes primary care (visits, examinations, laser treatment) and secondary care (inpatient/outpatient) |
| Rahman et al. [60] | Retrospective register study at the Glasgow Royal Infirmary Glaucoma Clinic | Lifetime | UK | Total mean annual direct glaucoma-specific health care cost per patient | £475.00 | GBP | 2011 | £499.38 | Disaggregated by (over the lifetime) outpatient costs, surgical cost, procedure costs, inpatient costs |
| Orme et al. [63] | Cost-effectiveness (Markov) model examining different sequences of medical management (latonoprost, bimatoprost, or travoprost as first line) | 10 years | UK | Total mean cumulative direct glaucoma-specific cost per patient over 10 years (latonoprost first line) | £6086.40 | GBP | 2008/2009 | £6770.27 | Disaggregated by medical therapy (first, second, and third line), scheduled and additional follow-up visits, surgery, long-term cost of low vision. Results were comparable for all first-line drugs |
| Sharma et al. [66] | Costing study of hospital-based glaucoma clinic with community optometrists | 1 year | UK | Mean annual clinic cost per patient—hospital | £102.25 | GBP | Not stated | N/A | Disaggregated as staff costs, non-pay costs (facilities, patient transport, domestics, interpreter, deprecation, sundries as lump sum), overhead |
| Mean annual clinic cost per patient—community | £254.17 | GBP | Not stated | N/A | Based on opportunity cost of running normal clinic (not disaggregated) | ||||
| Stein et al. [64] | Cost-effectiveness (Markov) model comparing observation only, prostaglandin medical therapy, and laser trabeculectomy in the US setting | 25 years | USA | Total estimated glaucoma-specific direct cost per patient over 25 years—observation only | $2700.00 | USD | 2010 | £1875.58 | Not disaggregated, but based on medication, laser surgery, trabeculectomy, initial and follow-up evaluations, diagnostics, low vision services (uni- and bilateral) |
| Total estimated glaucoma-specific direct cost per patient over 25 years—prostaglandin | $18,101.00 | USD | 2010 | £12,574.02 | As above | ||||
| Stein, Niziol et al. [71] | Longitudinal cohort study examining managed care claims data from 19,927 newly diagnosed OAG 2001 to 2009 with at least 2 years’ follow-up data | 2 years | USA | Cumulative mean total direct glaucoma-specific costs at 2 years | $2515.61 | USD | 2009 | £1785.56 | Total costs for all enrolled patients disaggregated by eye care providers (32%), glaucoma medications (31%), glaucoma diagnostic tests (16%), laser or incisional glaucoma surgeries (20%) |
| Holtzer-Goor et al. [67] | Economic evaluation alongside RCT. Monitoring of 815 stable glaucoma patients in glaucoma follow-up unit (GFU—optometrist and ophthalmic technicians) compared with usual care (glaucoma specialist). Costs reported from hospital, patient, health care, and societal perspective | 30 months | Netherlands | Mean annual direct cost of glaucoma-specific health care per patient (health care perspective)—GFU | €138.85 | EUR | 2007 | £109.76 | Breakdown by hospital visits, tests (HFA, refraction, pachymetry etc.), laser treatment, glaucoma surgery, advice |
| Mean annual direct cost of glaucoma-specific health care per patient (health care perspective) -usual care | €161.43 | EUR | 2007 | £127.61 | Breakdown by hospital visits, tests (HFA, refraction, pachymetry etc.), laser treatment, glaucoma surgery, advice | ||||
| Van Gestel et al. [65] | Discrete event simulation of the pathway of care for OHT and glaucoma patients across the life course, incl. medication switches, laser treatment, trabeculectomy, and care related to impaired vision. Comparison of no treatment and three strategies (A–C) with different IOP targets and visual field measurement frequencies | Lifetime | Netherlands | Mean total glaucoma-specific cost per patient over life course—no treatment | €41,618.00 | EUR | 2006 | £33,736.44 | Total costs not disaggregated, but unit costs extensively reported for medications, ophthalmologists, procedures (trabeculectomy, laser surgery, Baerveldt implant, cataract extraction etc.), low-vision aids, home care etc. in supplementary online material |
| Mean total glaucoma-specific cost per patient over life course—strategy A | €25,648.00 | EUR | 2006 | £20,790.82 | As above. Strategies B and C did not differ substantially from strategy A | ||||
| Kobelt et al. [61] | Prospective cohort of 602 patients enrolled through specialized hospitals or private practices in France, with uncontrolled IOP and treated with prostaglandin alone or in combination with other medications | 4 years | France | Total mean direct glaucoma-specific health care costs per patient over 4 years | €2204.00 | EUR | 2008 | £1953.51 | Disaggregated by medications, consultations/examinations, inpatient admissions, surgery (trabeculectomy, cataract, trabeculectomy/cataract, other), outpatient surgery |
| Pasquale et al. [89] | Retrospective cohort of 72,412 glaucoma patients from an insurance claims database | 1 year | USA | Mean annual total glaucoma-specific direct costs per patient | $1449 | USD | Not stated | N/A | Costs not disaggregated, but resource utilization disaggregated by visual field examination, scanning or laser ophthalmoscopy, optic nerve photographs, eye examination, trabeculoplasty, trabeculectomy, visual acuity, gonioscopy, serial tonometry or tonography, provocative test for glaucoma, laser iridotomy, and other ophthalmologic services and procedures |
| Lee et al. [68] | Cross-sectional cohort of 151 patients with glaucoma or OHT from 12 sites in the USA | 5 years | USA | Average annual glaucoma-specific direct costs per patient—stage 0 | $623 | USD | Not stated | N/A | Disaggregated (graphically) by office visits, visual field tests, medications, surgery, low-vision services, other services |
| Average annual glaucoma-specific direct costs per patient—stage 5 | $2511 | USD | Not stated | N/A | |||||
| Lindblom et al. [90] | Review of medical records of 267 patients in Sweden and France with glaucoma and ocular hypertension | 2 years | Sweden, France | Average annual glaucoma-specific direct costs per patient | €467.00 | EUR | 2002 | £407.56 | Disaggregated by consultations (26%), diagnostics/monitoring (16%), medications (49%), surgical procedures (5%), hospitalization (4%) |
| Denis et al. [70] | Cross-sectional retrospective study of resource utilization of 337 patients enrolled by 88 ophthalmologists in France | N/A | France | Mean annual glaucoma-specific direct and indirect cost (productivity loss)—no switches | €314.66 | EUR | 2001 | £281.32 | Breakdown by exam/outpatient surgery, drugs (majority of costs), visits, inpatient stays, indirect costs |
GFU glaucoma follow-up unit