Lee Paul P, Kelly Simon P, Mills Richard P, Traverso Carlo E, Walt John G, Doyle John J, Katz Laura M, Siegartel Lisa R
Duke University, Durham, NC, USA.
J Glaucoma. 2007 Aug;16(5):471-8. doi: 10.1097/IJG.0b013e3180575202.
Primary open-angle glaucoma is a significant health-economic burden in both the United States and Europe that is likely to increase. This study compared treatment patterns and cost among patients with primary open-angle glaucoma in these locations.
Retrospective medical chart reviews were conducted in the United States (1990 to 2002) and Europe (1995 to 2003). A total sample of 151 US charts and 194 European charts was studied, and patients were assigned a baseline intraocular pressure (IOP) and baseline stage, using a 6-stage visual functional glaucoma staging algorithm. Resource utilization and direct costs were assessed by stage of disease using publicly available United States and European costs. Cox Proportional Hazards modeling were used to examine covariates predicting glaucoma surgery. Total cost was predicted, adjusting for covariates using Generalized Linear Models, with baseline stage as the independent variable.
Glaucoma surgery requirement was highly associated with baseline disease stage and IOP increase before surgery in the United States and somewhat associated with these factors in Europe. Within both locations, baseline IOP was highly associated with glaucoma surgery requirement. Controlling for covariates, patients at higher baseline stages incurred greater costs in the United States (P=0.0017) and Europe (P=0.0715). Surgery and medication were also highly predictive of increased cost (P<0.0001). Cost of care differed greatly between the European countries, with costs lowest in Italy.
Increases in annual cost were related to higher baseline IOP, higher baseline stage, medication, and surgery. Thus, significant potential savings and reductions in annual healthcare burden are possible if patients are diagnosed and treated at earlier stages of glaucoma.
原发性开角型青光眼在美国和欧洲都是一项重大的健康经济负担，且负担可能会增加。本研究比较了这些地区原发性开角型青光眼患者的治疗模式和费用。
在美国（1990年至2002年）和欧洲（1995年至2003年）进行回顾性病历审查。共研究了151份美国病历和194份欧洲病历，并使用一种6阶段视觉功能青光眼分期算法为患者确定基线眼压（IOP）和基线分期。利用美国和欧洲公开的成本数据，按疾病分期评估资源利用情况和直接成本。采用Cox比例风险模型检验预测青光眼手术的协变量。使用广义线性模型对协变量进行调整，以基线分期作为自变量，预测总成本。
在美国，青光眼手术需求与基线疾病分期和术前眼压升高高度相关，在欧洲则与这些因素有一定关联。在这两个地区，基线眼压与青光眼手术需求都高度相关。在控制协变量后，美国（P=0.0017）和欧洲（P=0.0715）中基线分期较高的患者费用更高。手术和药物治疗也高度预示着费用增加（P<0.0001）。欧洲各国之间的护理费用差异很大，意大利的费用最低。
年度费用增加与较高的基线眼压、较高的基线分期、药物治疗和手术有关。因此，如果患者在青光眼的早期阶段得到诊断和治疗，就有可能大幅节省费用并减轻年度医疗负担。
