MedicalResearch.com Interview with:
Alisa Prager BS
Bernard and Shirlee Brown Glaucoma Research Laboratory
Department of Ophthalmology
Edward S. Harkness Eye Institute
Columbia University Medical Center, New York, New York
MedicalResearch: What is the background for this study?
Response: The goal of this research was to better understand the impact of glaucoma on non-ophthalmic healthcare use and costs. While there have been other studies assessing costs associated with glaucoma, these studies were primarily derived from either claims data or chart review. Our study used the Medicare Current Beneficiary Survey, which is a dataset that links claims data with survey results. The advantage of this is that the survey data allowed us to assess patient reported outcomes that did not necessarily prompt an encounter with the health care system, such as recent falls or feelings of sadness. The MCBS also provides complete expenditure and source of payment data on health services, including those not covered by Medicare, which allowed us to look at a more full spectrum of both private and public healthcare use and costs among Medicare beneficiaries.
MedicalResearch: What are the main findings?
Response: We found that Medicare beneficiaries with glaucoma have 27% higher likelihood of inpatient hospitalizations and home health aide visits compared to those without glaucoma, even after adjusting for covariates and excluding individuals who were admitted to the hospital with a diagnosis of glaucoma. When we stratified glaucoma patients based on self-reported visual disability, we found that those with self-reported visual disability were more likely to complain of depression, falls and difficulty walking compared to those without.
We also found that glaucoma patients incurred a predicted $2,903 higher mean annual total healthcare costs from all sources compared to those without glaucoma after adjusting for socioeconomic factors and comorbidities. Costs were higher among those who reported visual disability, and remained higher after excluding outpatient payments.
MedicalResearch: What should clinicians and patients take away from your report?
Response: The main take away from this report is that glaucoma is associated with greater non-ophthalmic health care utilization with resultant significant additional costs to society. We recommend following glaucoma patients, particular those who report worse vision, very closely for other medical conditions, specifically depression and mobility disturbances. For example, physicians could consider asking patients for their perception of visual loss to screen for depression and falls.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Response: We still need to better understand the reasons why glaucoma is associated with higher inpatient hospitalizations and home health aide use. This includes gaining a better understanding of the relationship between subjective visual loss and falls, depression and difficulty waking. In addition, analysis of indirect costs related to glaucoma, such as reduced productivity and wages for patients and their caregivers, may provide a more comprehensive picture of costs.
Prager AJ, Liebmann JM, Cioffi GA, Blumberg DM. Self-reported Function, Health Resource Use, and Total Health Care Costs Among Medicare Beneficiaries With Glaucoma. JAMA Ophthalmol. Published online January 07, 2016. doi:10.1001/jamaophthalmol.2015.5479.