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J. D. Stein, N. Talwar, B. Nan, S. M. Kymes, D. C. Musch; Who Are the Costliest Recipients of Eye Care in the United States?. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5833.
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© ARVO (1962-2015); The Authors (2016-present)
To identify in a large managed care network the sociodemographic characteristics, ocular conditions and ocular surgical procedures of the costliest eye care recipients.
Billing records from 2001-2007 for all beneficiaries continuously enrolled in a managed care network for >1 year were reviewed. Charges for eye-related visits, diagnostic and therapeutic ocular procedures, and ocular medications were aggregated; an average yearly charge was computed for each beneficiary. Beneficiaries were ranked from highest to lowest for annual eye-related charges. Logistic regression was performed to determine the sociodemographic characteristics, ocular conditions, and surgical procedures associated with being in the top 1% for eye-related charges.
Of 4,004,054 persons in the dataset, the 40,041 beneficiaries in the top 1% for eye-related charges had total eye-related charges of $1.01 billion, accounting for 21% of the overall eye-related charges over the 7-year period. The 200,203 persons in the top 5% for eye-related charges had $2.72 billion, or 57%, of the overall eye-related charges. By comparison, those in the lower 50% for eye-related charges accounted for only 7% ($343 million) of the overall eye-related charges. After adjustment for confounding factors, racial minorities, the least-educated persons, and those with estimated net worth <$25,000 were more likely than others to be in the top 1% for eye-related charges. Persons with proliferative diabetic retinopathy (OR=5.41 [CI=5.07-5.79]) and clinically significant macular edema (OR=2.56 [CI=2.39-2.75]) had substantially higher odds of being in the top 1% while those with nonproliferative diabetic retinopathy (OR=1.25 [CI=1.18-1.32]) had only slightly increased odds, compared with those with no retinopathy. Persons with endophthalmitis (OR=3.24 [CI=2.79-3.76]) and suprachoroidal hemorrhage (OR=2.67 [CI=2.10-3.39]) had significantly increased odds of being in the top 1% for eye-related charges.
In this large sample, racial minorities and those with less education or wealth are more likely to have the highest annual eye-care charges, as are those with surgical complications or more severe ocular manifestations of diseases. These findings support the allocation of resources to identify and treat patients in underserved communities, and provide evidence that may lead to reducing undue costs associated with eye care.
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