Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK.
Glaukos UK Ltd, London, UK.
J Med Econ. 2020 Jan;23(1):106-112. doi: 10.1080/13696998.2019.1646262. Epub 2019 Aug 13.
Falls have devastating consequences in older people with a considerable cost burden. Glaucoma is a risk factor for falls, and patients with glaucoma who fall are at high risk of hospital admission. The aim was to quantify the cost burden of falls to NHS Trusts in people with glaucoma in the UK. Financial data were used to identify non-elective episodes and associated costs from 2012 to 2018, for all admissions where glaucoma was recorded as a secondary diagnosis and admissions for falls (all, with and without a glaucoma secondary diagnosis). A secondary diagnosis is only recorded by the admitting clinician if it is clinically relevant; therefore, a secondary diagnosis of glaucoma was used as a proxy for glaucoma as a contributory factor to falls. Use of financial records means that data on other falls risk factors was unavailable and we cannot be certain that glaucoma was the only relevant factor in all falls. Although this methodology is imperfect, case capture was biased towards cases with clinically significant glaucoma, and financial data is robust. Potential coding errors mean that we may have excluded patients in whom glaucoma was a factor in their fall. At Maidstone and Tunbridge Wells (MTW) NHS Trust, 11.7% (95% confidence intervals [CI] = 10.7-12.8) of admissions for falls were in patients with a secondary diagnosis of glaucoma. This extrapolates to an estimated annual 10,056 admissions at a cost of £28.6 million across the UK. This is an under-estimate of cost, as A&E attendance without admission and outpatient appointments are excluded. At MTW, glaucoma potentially plays a part in around one in eight falls resulting in hospital admission, at considerable personal and financial cost. It is suggested that further work should explore early diagnosis of glaucoma, treatment, and mitigation of falls risk.
老年人跌倒后果严重，经济负担沉重。青光眼是跌倒的一个风险因素，患有青光眼且跌倒的患者住院风险很高。本研究旨在量化英国青光眼患者跌倒给国民保健制度信托基金带来的经济负担。利用财务数据，从 2012 年至 2018 年，确定了所有因青光眼被记录为次要诊断以及因跌倒而入院（所有、有和没有青光眼次要诊断）的非选择性住院病例和相关费用。只有当次要诊断与临床相关时，主治医生才会记录次要诊断；因此，青光眼的次要诊断被用作青光眼是导致跌倒的一个促成因素的替代指标。由于使用财务记录，因此无法获得其他跌倒风险因素的数据，我们不能确定在所有跌倒中，青光眼是唯一相关因素。尽管这种方法并不完美，但病例捕获偏向于有明显临床意义的青光眼病例，且财务数据是可靠的。潜在的编码错误意味着我们可能排除了青光眼是其跌倒因素的患者。在梅德斯通和滕布里奇韦尔斯（MTW）国民保健制度信托基金中，11.7%（95%置信区间 [CI] = 10.7-12.8）的跌倒住院病例有青光眼的次要诊断。这推断出英国每年约有 10056 例住院，费用为 2860 万英镑。由于不包括急诊就诊但未入院和门诊预约的情况，这是对成本的低估。在 MTW，青光眼可能在导致住院的约八分之一跌倒中起作用，这给个人和经济带来了巨大的负担。建议进一步研究应探索青光眼的早期诊断、治疗和跌倒风险的缓解。
