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Treating Glaucoma Early Lowers Economic Burden

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Duke Health News 919-660-1306

Durham, N.C. — Treatments that delay the progression of
glaucoma may significantly reduce the economic health burden on
people with the disease and on the U.S. health system,
according to a new study by researchers at Duke University Eye Center and
elsewhere. Their findings appear in the January 9, 2006, issue
of Archives of
Ophthalmology
.

The team determined that patients with early-stage or
suspected glaucoma use approximately $623 per year in health
care resources, while patients with end-stage disease consume
approximately $2,511. The cost of medication was responsible
for one-third to half of the total direct cost to
consumers.

"It is imperative that patients with glaucoma be
well-monitored for changes in their disease," said Paul Lee,
M.D., a glaucoma specialist at Duke University Eye Center and
lead author on the study. "Our results prove what we've thought
for a long time – that the disease gets more expensive as it
worsens. With effective treatments at earlier stages, the
progression of disease can be slowed or halted – saving both
the patient and society from greater economic burden."

Glaucoma is a leading cause of blindness in the U.S.,
affecting an estimated 2.2 million adults, the researchers
said. Experts anticipate the overall number of people living
with glaucoma to rise as the number of elderly Americans
increases. Glaucoma is a group of eye diseases that damage the
cells and fibers of the optic nerve, interrupting the
transmission of visual signals from the eye to the brain. The
disease is believed to be caused by a level of intraocular
pressure (IOP) that is too high, although other mechanisms are
likely to be involved since people can develop the disease and
have a normal IOP. Many people go undiagnosed during early
stages of the disease because symptoms are virtually
undetectable without an eye exam.

In their study, the team sought to determine whether the
costs of managing glaucoma varied as the disease progressed in
order to understand the relationship of patients' use of health
resources to the severity of their disease.

They analyzed 151 randomly selected records of adult
patients (average age was 66.3 years) with different severities
of primary open-angle or normal tension glaucoma, as well as
those suspected of having either glaucoma or ocular
hypertension. They obtained records from 12 study sites
throughout the U.S.

The researchers categorized patient records according to the
severity of the patients' glaucoma. For each stage of severity,
the researchers obtained economic data on the cost of the
patients' use of eye care visits, visual field and other
diagnostic testing, treatment procedures, low vision and other
rehabilitation services, and prescribed medications. While the
researchers based the medication costs used in the study on
wholesale prices, they said actual costs might be higher
because consumers typically pay more than the wholesale
cost.

"We know that for chronic diseases such as glaucoma, people
don't use their medications as frequently as recommended by
their physician," said Lee. "We took this into account in our
study, but we suspect that the true costs of medication use
could be even greater than we found."

The researchers found that aggressiveness of glaucoma
treatment increased over time with worsening of the disease,
except for patients with end-stage glaucoma. That
aggressiveness is likely to drop off in patients who have gone
blind from glaucoma because treatment options for those
patients may not offer significant benefits, said Lee.

"Since our data were collected, additional treatments have
become available," Lee added. "However, these medications are
fairly expensive. Ultimately, it may cost patients and society
more to care for patients in earlier stages of the disease –
but over the long-term, when managed correctly and effectively,
glaucoma patients can retain more of their vision and therefore
remain more productive with a presumably higher quality of
life."

The research was funded by an unrestricted grant from
Allergan, Inc., Irvine, CA.

Other authors on the study include John G. Walt, Allergan;
John J. Doyle, Sameer V. Kotak and Stacy J. Evans, M.D., of The
Analytica Group, New York; Donald L. Budenz, M.D., University
of Miami; Philip P. Chen, M.D., University of Washington,
Seattle; Anne L. Coleman, M.D., Ph.D., Jules Stein Eye
Institute, UCLA, Los Angeles; Robert M. Feldman, M.D.,
University of Texas, Houston; Henry D. Jampel, M.D., Johns
Hopkins University, Baltimore, MD; L. Jay Katz, M.D. and
Johnathan S. Myers, M.D., of Wills Eye Hospital, Philadelphia;
Richard P. Mills, M.D., University of Kentucky, Lexington, KY;
Robert J. Noecker, M.D., University of Arizona, Tucson, AZ;
Jody R. Piltz-Seymour, M.D., University of Pennsylvania Health
System, Philadelphia; Robert R. Ritch, M.D., New York Eye &
Ear Infirmary, New York; Paul N. Schacknow, M.D., Ph.D., Palm
Beach Eye Foundation, Lake Worth, FL; Janet B. Serle, M.D.,
Mount Sinai School of Medicine, New York; and Gary L. Trick,
Ph.D., Henry Ford Health System, Detroit, MI.

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