Department of Ophthalmology, New York University School of Medicine, New York, New York, USA.
Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA; Center for Eye Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.
Am J Ophthalmol. 2019 Apr;200:100-109. doi: 10.1016/j.ajo.2018.12.024. Epub 2019 Jan 8.
To characterize differences in resource utilization and cost of managing enrollees with exfoliation glaucoma (XFG) compared to primary open-angle glaucoma (POAG).
Retrospective utilization and cost comparison using Medicare claims data.
We identified Medicare beneficiaries with XFG or POAG and ≥5 years of continuous enrollment from January 2008 to December 2014. We distinguished newly diagnosed cases from those with preexisting disease. We compared ophthalmic resource utilization and costs over 2 years of follow-up for persons with newly diagnosed and preexisting XFG vs those with POAG. Main outcome measures were number of clinic visits, diagnostic procedures, medication fills, laser and incisional surgery, and mean eye care costs per beneficiary.
Among 192 eligible enrollees (median age 77.6 years) with newly diagnosed XFG and 7339 enrollees (median age 77.3 years) with newly diagnosed POAG, those with XFG had more office visits (mean, 9.1 vs 7.9; P = .001), cataract surgery (34.9% vs 19.0%; P < .0001), and glaucoma surgery (28.7% vs 19.7%, P = .002). They also experienced 27% higher mean total eye care costs ($3260 vs $2562, P = .0001) over 2 years of follow-up. Among 2745 enrollees (median age 80.5 years) with preexisting XFG and 89 036 persons (median age 79.5) with preexisting POAG, persons with XFG had more office visits (mean 9.3 vs 7.3; P < .0001), perimetry (85.3% vs 79.8%; P < .0001), cataract surgery (23.4% vs 12.3%; P < .0001), laser trabeculoplasty (18.6% vs 9.6%; P < .0001), and trabeculectomy (8.1 vs 1.8%; P < .0001) and experienced 37% higher total mean eye care costs ($3764 vs $2739; P < .0001).
Healthcare resource utilization and costs are substantially higher for managing patients with XFG compared to POAG.
描述与原发性开角型青光眼（POAG）相比，剥脱性青光眼（XFG）患者管理中资源利用和成本的差异。
使用医疗保险索赔数据进行回顾性利用和成本比较。
我们确定了 2008 年 1 月至 2014 年 12 月期间有 XFG 或 POAG 且连续参保 5 年以上的医疗保险受益人的数据。我们区分了新发病例和既往疾病病例。我们比较了新发和既往 XFG 患者与 POAG 患者在 2 年随访期间的眼科资源利用和成本。主要结局指标为就诊次数、诊断程序、药物用量、激光和手术治疗以及每位患者的平均眼科护理费用。
在 192 名符合条件的新发 XFG 患者（中位年龄 77.6 岁）和 7339 名新发 POAG 患者（中位年龄 77.3 岁）中，XFG 患者的就诊次数更多（平均 9.1 次 vs 7.9 次；P =.001），白内障手术（34.9% vs 19.0%；P <.0001）和青光眼手术（28.7% vs 19.7%；P =.002）也更多。他们在 2 年的随访中还经历了 27%的平均总眼科护理费用（3260 美元 vs 2562 美元；P =.0001）的增加。在 2745 名既往 XFG 患者（中位年龄 80.5 岁）和 89036 名既往 POAG 患者（中位年龄 79.5 岁）中，XFG 患者的就诊次数更多（平均 9.3 次 vs 7.3 次；P <.0001），视野检查（85.3% vs 79.8%；P <.0001）、白内障手术（23.4% vs 12.3%；P <.0001）、激光小梁成形术（18.6% vs 9.6%；P <.0001）和小梁切除术（8.1% vs 1.8%；P <.0001）更多，总平均眼科护理费用高出 37%（3764 美元 vs 2739 美元；P <.0001）。
与 POAG 相比，XFG 患者的医疗资源利用和成本要高得多。
