June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Laser trabeculoplasty in open-angle glaucoma: healthcare costs and predictors of treatment
Author Affiliations & Notes
  • Neil M Schultz
    Department of Pharmacy Science and Practice, University of Arizona, Tucson, AZ
  • William Wong
    Global Health Outcomes Strategy and Research, Allergan, Inc., Irvine, CA
  • Anne L Coleman
    Department of Ophthalmology, Jules Stein Eye Institute, University of California - Los Angeles, Los Angeles, CA
  • Daniel C Malone
    Department of Pharmacy Science and Practice, University of Arizona, Tucson, AZ
  • Footnotes
    Commercial Relationships Neil Schultz, Allergan, Inc. (F); William Wong, Allergan, Inc. (E); Anne Coleman, Allergan, Inc. (R); Daniel Malone, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 2127. doi:
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    • Get Citation

      Neil M Schultz, William Wong, Anne L Coleman, Daniel C Malone; Laser trabeculoplasty in open-angle glaucoma: healthcare costs and predictors of treatment. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2127.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

Laser trabeculoplasty (LT) is an alternative to topical medications for the treatment of open-angle glaucoma (OAG). However, patient characteristics and healthcare costs associated with receiving LT have not been well studied. The purpose of this analysis was: (1) identify predictors of LT treatment vs. continuation of glaucoma medications (Rx); and (2) estimate the resource utilization and costs associated with the use of LT vs. Rx.

 
Methods
 

This study used medical and pharmacy data between 2007-2012 from an insurance claims dataset that included over 150 million individuals. Patient inclusion required at least two OAG ICD-9-CM codes one week apart and an LT claim (LT cohort index date) or second medication class claim (Rx cohort index date) after prior treatment with prostaglandin analog monotherapy. Patients were followed for 12 months pre and 24 months post index date. Attributes used to predict use of LT therapy included age, sex, employment status, Rx adherence, number of comorbidities, and geographic region. Costs included glaucoma specific Rx and CPT codes. Medical encounters and Rx claims were evaluated pre and post treatment. Comparisons between the groups were analyzed using Chi-square and Student’s t-tests (descriptive); logistic regression (predictive); and generalized linear models (cost).

 
Results
 

The study included 4,743 LT and 16,484 Rx patients. Baseline demographics age, sex and employment status were similar among cohorts. Significant differences were observed with respect to co-morbidities, glaucoma Rx adherence, and geographic region. Younger age (odds ratio (OR): 1.21; p<0.001), low Rx adherence (OR: 1.18; p=0.001), high co-morbid disease burden (OR: 1.12; p=0.006), and geographic region (OR: 1.50; p<0.001) significantly predicted use of LT. Of patients treated with LT, 60% did not have an Rx claim within 45 days after treatment; however by two years this proportion reduced to 22%. LT was associated with significantly higher medical ($2,684 vs. $1,980; p<0.001), lower pharmacy ($807 vs. $1,467; p<0.001), and higher overall costs ($3,441 vs. $3,408 p=0.002).

 
Conclusions
 

Poor Rx adherence, age, and number of comorbidities were predictors of receiving LT among OAG patients. Despite the potential for LT to address poor adherence, most patients had a claim for an Rx within two years after LT. Overall healthcare costs were greater among persons receiving LT compared to Rx therapy.

 
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