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Original Investigation |

Self-reported Function, Health Resource Use, and Total Health Care Costs Among Medicare Beneficiaries With Glaucoma

Alisa J. Prager, BS1; Jeffrey M. Liebmann, MD1; George A. Cioffi, MD1; Dana M. Blumberg, MD, MPH1
[+] Author Affiliations
1Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
JAMA Ophthalmol. 2016;134(4):357-365. doi:10.1001/jamaophthalmol.2015.5479.
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Importance  The effect of glaucoma on nonglaucomatous medical conditions and resultant secondary health care costs is not well understood.

Objective  To assess self-reported medical conditions, the use of medical services, and total health care costs among Medicare beneficiaries with glaucoma.

Design, Setting, and Participants  Longitudinal observational study of 72 587 Medicare beneficiaries in the general community using the Medicare Current Beneficiary Survey (2004-2009). Coding to extract data started in January 2015, and analyses were performed between May and July 2015.

Main Outcomes and Measures  Self-reported health, the use of health care services, adjusted mean annual total health care costs per person, and adjusted mean annual nonoutpatient costs per person.

Results  Participants were 72 587 Medicare beneficiaries 65 years or older with (n = 4441) and without (n = 68 146) a glaucoma diagnosis in the year before collection of survey data. Their mean age was 76.9 years, and 43.2% were male. Patients with glaucoma who responded to survey questions on visual disability were stratified into those with (n = 1748) and without (n = 2639) self-reported visual disability. Medicare beneficiaries with glaucoma had higher adjusted odds of inpatient hospitalizations (odds ratio [OR], 1.27; 95% CI, 1.17-1.39; P < .001) and home health aide visits (OR, 1.27; 95% CI, 1.13-1.43; P < .001) compared with Medicare beneficiaries without glaucoma. Furthermore, patients with glaucoma with self-reported visual disability were more likely to report depression (OR, 1.47; 95% CI, 1.26-1.71; P < .001), falls (OR, 1.34; 95% CI, 1.09-1.66; P = .006), and difficulty walking (OR, 1.22; 95% CI, 1.02-1.45; P = .03) compared with those without self-reported visual disability. In the risk-adjusted model, Medicare beneficiaries with glaucoma incurred an additional $2903 (95% CI, $2247-$3558; P < .001) annual total health care costs and $2599 (95% CI, $1985-$3212; P < .001) higher costs for nonoutpatient services compared with Medicare beneficiaries without glaucoma.

Conclusions and Relevance  Glaucoma is associated with greater use of inpatient and home health aide services and with higher annual total and nonoutpatient medical costs. Perception of vision loss among patients with glaucoma may be associated with depression, falls, and difficulty walking. Reducing the prevalence and severity of glaucoma may result in improvements in associated nonglaucomatous medical conditions and resultant reduction in health care costs.

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Figure 1.
Breakdown of the Mean Annual Total Health Care Costs per Person

HMO indicates health maintenance organization. A subanalysis was performed for individuals with glaucoma who responded to survey questions regarding self-reported visual disability. Because not all individuals answered these questions, the number of participants in the subanalysis may not add up to the total glaucoma cohort. Costs presented in 2015 US dollars.

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Figure 2.
Breakdown of the Mean Annual Nonoutpatient Health Care Costs per Person by Health Care Service

Error bars indicate SEs. Costs presented in 2015 US dollars.

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