Incremental Healthcare Service Utilization for Open-angle Glaucoma: A Population-Based Study

Outcomes and Revenue Generation of a Community-based Screening at a Center in the United States: The SToP Glaucoma Program

PRCIS

Of 611 individuals seen at referral clinic visits following community screenings, 76% were diagnosed with ≤1 eye condition needing treatment, generating a total of $213,110 in collections for the institution over 2.5 years.

PURPOSE

The purpose of this study was to examine the outcomes and revenue generation of community-based eye screenings.

MATERIALS AND METHODS

Individuals aged 50 years and above screened at community sites in Baltimore, MD, with abnormal ophthalmic findings were referred for one free-of-charge definitive eye examination at the Wilmer Eye Institute. Diagnoses, treatment, and billing information were abstracted from electronic medical records of patients subsequently seen at Wilmer from January 1, 2016, to July 31, 2018.

RESULTS

A total of 611 individuals attended 3696 encounters at Wilmer during this time period. Most patients were female (60.3%) and African American (83.7%). At the screening event, 82.9% reported difficulty seeing when not wearing corrective eyewear, although only 49.8% reported having visited an eye doctor within the last 2 years. The majority (60.2%) reported having Medicare/Medicaid coverage, and 8.1% reported being uninsured. At the definitive eye examination after the screening, 75.5% of patients were diagnosed with ≥1 eye condition, most commonly cataract (30.3%), suspicion of glaucoma (24.9%), manifest glaucoma (11.9%), diabetic retinopathy (5.4%), and ocular hypertension (2.6%). Overall, 430 (70.4%) individuals required treatment including surgery (n=106), intravitreal injections (n=14), laser procedures (n=9), and medications (n=48). A total of $213,110 was collected for visits and procedures after the initial referral visit during the study period.

CONCLUSIONS

A large community-based vision screening program in Baltimore was able to identify ocular conditions requiring treatment in underserved older adults and connect them to eyecare. Our findings also highlight that this model simultaneously generates new revenue streams for the institution organizing the community screenings.

The Prevalence and the Incidence of Diagnosed Open-Angle Glaucoma and Diagnosed Angle-Closure Glaucoma: Changes From 2001 to 2010

PURPOSE

To explore the trends in diagnosed open-angle glaucoma (OAG) and diagnosed angle-closure glaucoma (ACG) in Taiwan during the period of 2001 to 2010.

MATERIALS AND METHODS

Data were sourced from the National Longitudinal Health Insurance Database 2000 (LHID2000). The study population comprised all patients with a diagnosis of OAG or ACG (International Classification of Diseases, 9th Revision, Clinical Modification codes 365). Patients were stratified by their sex and age; differences in standardized incidence rates were compared between the stratified groups.

RESULTS

Throughout the study period, the prevalence of diagnosed OAG (slope=0.18, P<0.0001) and ACG (slope=0.09, P<0.0001) increased. Before 2005, the prevalence of ACG was higher than that of OAG; however, from 2005 to 2010, the prevalence of OAG was higher than that of ACG. The standardized incidence of diagnosed OAG increased insignificantly (slope=1.06, P=0.18), and that of diagnosed ACG decreased significantly (slope=-1.17, P=0.009). The prevalence and the incidence of OAG and ACG were the highest among people of advanced age. Women had higher standardized incidence rates of ACG during the study period. Men had higher standardized incidence rates of OAG in every year of the study with the exception of 2007.

CONCLUSIONS

In Taiwan, ACG was more prevalent in women and OAG might be more prevalent in men. The prevalence of ACG was higher than that of OAG before 2005, but the prevalence of OAG has been higher than that of ACG since 2005.

Tolerability and efficacy of bimatoprost 0.01 % in patients with open-angle glaucoma or ocular hypertension evaluated in the Taiwanese clinical setting: the Asia Pacific Patterns from Early Access of Lumigan 0.01 % (APPEAL Taiwan) study

BACKGROUND

In randomized, controlled trials of open-angle glaucoma (OAG) or ocular hypertension (OHT), bimatoprost 0.01 % improved tolerability while retaining the intraocular pressure (IOP)-lowering efficacy of bimatoprost 0.03 %. Given geographic/racial differences in glaucoma presentation, the APPEAL study assessed the occurrence and severity of hyperemia produced by bimatoprost 0.01 %, and its efficacy, in the Taiwanese clinical setting.

METHODS

In this multicenter, open-label, observational study, treatment-naïve and previously treated patients with OHT or OAG received once-daily bimatoprost 0.01 % for 12 weeks. Hyperemia (primary endpoint) was graded at baseline, week 6, and week 12 using a photonumeric scale (0, +0.5, +1, +2, +3), grouped (≤ +1, none to mild; ≥ +2, moderate to severe), and reported as unchanged from baseline, improved, or worsened. IOP assessments followed the same schedule. Supplemental efficacy analyses were conducted based on previous therapies.

RESULTS

The intent-to-treat population (N = 312) included treatment-naïve (13.5 %) and previously treated (86.5 %) patients; mean age was 53.3 years. At baseline, 46.3 % of previously treated patients were receiving prostaglandin analog (PGA) monotherapy. At week 12, 91.2 %, 5.9 %, and 2.9 % of treatment-naïve patients exhibited unchanged, worsened, and improved hyperemia from baseline, respectively; 77.9 %, 12.9 %, and 9.2 % of previously treated patients showed no change, worsening, and improvement, respectively. There were no statistically significant shifts in hyperemia severity in either group, or in subgroups based on previous use of any PGA, any non-PGA, latanoprost, or travoprost monotherapies. In treatment-naïve patients, mean IOP reduction from baseline (18.0 ± 3.8 mm Hg) was 3.6 mm Hg at week 12 (P < 0.0001); 83.3 % had baseline IOP ≤ 21 mm Hg. In previously treated patients, mean additional IOP reduction from baseline (17.8 ± 3.9 mm Hg) was 2.6 mm Hg (P < 0.0001); similar results were observed in patient subgroups based on previous therapies.

CONCLUSIONS

In the Taiwanese clinical setting, bimatoprost 0.01 % provided significant IOP lowering in treatment-naïve patients (regardless of baseline IOP) and previously treated patients (even those with relatively low IOP on other therapies), while causing no significant changes in hyperemia from baseline.

TRIAL REGISTRATION

Clinicaltrials.gov NCT01814761 . Registered 18 March 2013.

Geographical variation in glaucoma prescribing trends in England 2008-2012: an observational ecological study

OBJECTIVES

To explore (1) the national trend in population-adjusted prescription rates for glaucoma and ocular hypertension (OHT) in England and (2) any geographical variation in glaucoma/OHT prescribing trends and its association with established risk factors for primary open-angle glaucoma (POAG) at the population level.

DESIGN

Observational ecological study.

SETTING

Primary care in England 2008-2012.

PARTICIPANTS

All patients who received 1 or more of the 37 778 660 glaucoma/OHT prescription items between 2008 and 2012.

PRIMARY AND SECONDARY OUTCOME MEASURE METHODS

Glaucoma/OHT prescription statistics for England and its constituent primary care trusts (PCTs) between 2008 and 2012 were divided by annual population estimates to give prescription rates per 100 000 population aged ≥40 years. To examine regional differences, prescription rates and the change in prescription rates between 2008 and 2012 for PCTs were separately entered into multivariable linear regression models with the population proportion aged ≥60 years; the proportion of males; the proportion of West African Diaspora (WAD) ethnicity; PCT funding per capita; Index of Multiple Deprivation 2010 score and its domains.

RESULTS

Between 2008 and 2012, glaucoma/OHT prescriptions increased from 28 029 to 31 309 items per 100 000 population aged ≥40 years. Between PCTs, nearly a quarter of the variation in prescription rates in 2008 and 2012 could be attributed to age, WAD ethnicity and male gender. The change in prescription rates between 2008 and 2012 was only modestly correlated with age (p=0.003, β=0.234), and income deprivation (p=0.035, β=-0.168).

CONCLUSIONS

Increased population-adjusted glaucoma/OHT prescription rates in the study period were likely due to increased detection of POAG and OHT cases at risk of POAG. Between PCTs, regional variation in overall prescription rates was partly attributable to demographic risk factors for POAG, although the change in prescription rates was only modestly correlated with the same risk factors, suggesting potential variation in practice.