Longitudinal Trends in Resource Utilization Associated With Newly Diagnosed Primary Angle Closure Glaucoma in the United States.

Précis: The average cumulative 2-year cost following first primary angle closure glaucoma diagnosis was $2960. Elderly and Black patients were at higher risk of being among the costliest 5% (>$9813) of cases, accounting for 21.3% of costs.

Purpose

To assess longitudinal eye care costs associated with newly diagnosed primary angle closure glaucoma (PACG) in the United States.

Methods

Patients with a diagnosis of PACG between 2009 and 2017 were identified in Optum's deidentified Clinformatics Data Mart Database based on International Classification of Diseases (ICD) codes. Newly diagnosed PACG was defined as: (1) diagnosis by an ophthalmologist or optometrist; (2) observable for at least 12 months before and 24 months after index diagnosis; (3) no prior history of glaucoma treatment; (4) PACG-related treatment initiated after index diagnosis. Logistic regression modeling was performed to identify risk factors for being in the top 5% of cumulative 2-year costs.

Results

Among 12,673 eligible patients, the average cumulative 2-year cost following first PACG diagnosis was $2960. Patient costs were highest in the 6 months immediately following diagnosis, accounting for 52.3% of all 2-year costs. 56.7% of all 2-year costs were related to treatment procedures. The costliest 5% (>$9813) of patients accounted for 21.3% of all 2-year PACG-related costs. Risk factors for being in the costliest 5% ( P <0.05) included older age, Black race, PPO or other Medicare insurance product, living in the Midwest or the South, and recent diagnosis of anatomic narrow angles (ANA).

Conclusion

Costs associated with newly diagnosed PACG were found to be disproportionately driven by a small subset of cases. Elderly and Black patients were more likely to be within the top 5% of cumulative 2-year costs. Identifying and preventing the costliest PACG cases could reduce PACG-related eye care expenditures.