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Anik Patel, Chi-Chang Chen, Catherine McGuiness, Joanna Campbell; Treatment Experience of Open Angle Glaucoma Patients Undergoing Trabeculectomy in the US. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5229.
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Trabeculectomy is the mainstay surgery for advanced glaucoma patients who have failed initial topical and laser therapies. However, post-trabeculectomy management and economic burden are not well characterized. The objective of this study was to describe the patient characteristics and healthcare resource utilization of open angle glaucoma (OAG) and ocular hypertension (OHT) patients undergoing trabeculectomy.
This was a retrospective analysis utilizing the IQVIA PharMetrics Plus claims database. The study sample included patients diagnosed with OAG or OHT and subsequently treated with trabeculectomy in 2012. Patients were continuously enrolled in the 12-month pre-index and 36-month post-index period. Patients who received cataract surgery as a therapeutic procedure for OAG were excluded from this analysis.
A total of 416 patients met the eligibility criteria, of whom 205 (49.3%) were female, 186 (44.7%) were over the age of 65, and 82 (19.7%) had a physical or mental co-morbidity that could affect their ability to use drops. In the 12-months pre-trabeculectomy, more than half the patients (n = 245; 58.9%) were on three or more topical medication classes. During the 36-month post-trabeculectomy follow-up (n=413), about 50% of patients had more than 13.0 eye-related office visits (physician or laboratory) with a mean of 15.5 (SD=11.1) visits at a mean total cost of $5,985 (SD=$8,837). A majority of patients (N=314, 75.5%) continued glaucoma drop therapy with an average of 20.4 (SD=18.6) unique fills at a mean total cost of $2,022 (SD=$2,291). Of note, 91 (21.9%) patients received the same or an increased number of medication classes within the 4-6 month period post-trabeculectomy. Post-operative complications observed in the follow-up period included hypotony (n=36, 8.6%), blebitis/endophthalmitis (n=21, 4.7%) and fitting of a bandage lens (n=9, 2.2%). Finally, close to half (N=176, 44.0%) of the patients received additional eye surgery after index trabeculectomy in the follow-up period.
Trabeculectomy is associated with substantial eye-care visits, complications, drop therapy and costs. A significant proportion of patients do not reduce topical drop-use post-procedure. While trabeculectomy is the gold standard for surgical lowering of IOP in OAG, postoperative management burden and costs remain high.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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