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M. Dolgitser, J. G. Walt, J. J. Doyle, L. S. Stern, D. Wiederkehr, E. Malangone, L. R. Pasquale; Healthcare Charges in Glaucoma Patients Who Undergo Laser Trabeculoplasty. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1587.
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A recent study assessing the impact of transition from ocular hypertension to primary open-angle glaucoma (POAG) on healthcare charges found that patients who underwent laser trabeculoplasty (ALT) were 3.4 times more likely to experience an increase in ophthalmology-related charges than patients who did not undergo ALT. Our study evaluates the impact of ALT on healthcare charges in a POAG patient population while controlling for glaucoma duration and other key covariates.
1,145 cases and 2,290 controls with ≥ 2 years of continuous enrollment (PharMetrics; 1998-2005) and ≥ 2 ICD-9 codes for POAG (365.11) were identified. Cases had a CPT code for ALT (65855; date of first code defined as index date) at any time after their first POAG diagnosis. Controls had no ALT at any time and were matched to cases (on gender, age, and index year) in a 1:2 ratio. Healthcare charges were calculated in the year pre- and post-index date; calculations excluded date of surgery to control for the cost of surgery. Conditional logistic regression models determined the impact of the ALT on change in healthcare charges (from the year pre- to the year post-index date).
In univariate analysis, cases had significantly higher increases in ophthalmology-related charges ($1,365 vs. $30, p=0.0003) and total charges ($5,084 vs. $1,594, p=0.0085) from the year pre- to the year post-index date when compared to controls. After adjusting for key covariates, cases were 1.44 times (95% CI: 1.24,1.67) more likely to have increased total charges and 2.08 times (95% CI: 1.79,2.42) more likely to have increased ophthalmology-related charges compared to controls.
POAG patients who undergo ALT are significantly more likely to have increases in total and ophthalmology-related healthcare charges the year following ALT than patients who do not undergo this surgery, even after controlling for the costs of surgery and other key covariates. Contrary to popular belief, undergoing ALT may not result in savings of healthcare resources.
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