Rates of Glaucoma Medication Utilization among Persons with Primary Open-angle Glaucoma, 1992 to 2002
Received 7 June 2007; received in revised form 11 December 2007; accepted 13 December 2007. published online 04 March 2008.
Objective
To determine the percentage of Medicare beneficiaries with primary open-angle glaucoma (POAG) treated medically or surgically, utilization rates for each major class of glaucoma medication, and factors influencing treatment.
Design
Longitudinal observational study using data from the Medicare Current Beneficiary Survey (MCBS).
Participants
Persons age 65 and older with POAG, 1992 to 2002 (N = 6446).
Methods
By using MCBS data merged with Medicare claims, rates of medical and surgical treatment for participants with POAG were determined. Logistic analysis was used to assess factors associated with use of care.
Main Outcome Measures
Receipt/nonreceipt of medical or surgical therapy in a year and rates of drug utilization by class and of surgery by type among persons who did not receive medical therapy in a year.
Results
On average from 1992 to 2002, 27.4% of persons diagnosed with POAG received no medical or surgical treatment. Rates of nonuse increased by 3% annually (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02–1.05). Beneficiaries with Medicaid were 43% more likely not to receive care for POAG in a year (OR, 1.43; 95% CI, 1.20–1.70). Hispanic, Asian, and beneficiaries of other race/ethnicity were less likely to receive treatment than were whites. Use of β-blockers and miotics decreased, but utilization rates increased substantially for α-agonists, combination β-blocker–carbonic anhydrase inhibitors, and especially prostaglandin analogs.
Conclusions
Despite availability of more efficacious glaucoma medication classes with few side effects and findings of clinical trials underscoring the importance of intraocular pressure reduction in POAG patients, many patients with POAG continue to go untreated.
Available online: March 5, 2007.
1Kellogg Eye Center, University of Michigan Department of Ophthalmology, Ann Arbor, Michigan.
2Department of Economics, Duke University, Durham, North Carolina.
3Center for Health Policy, Duke University, Durham, North Carolina.
4Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
Correspondence to Frank A. Sloan, PhD, Center for Health Policy, Rubenstein Hall 114, Box 90253, Duke University, Durham, NC 27708.
Manuscript no. 2007-767.
No conflicting relationships exist for any author.
Supported by the National Institute on Aging, Bethesda, Maryland (grant no. 2R 37-AG-17473-05A1), and Heed Ophthalmic Foundation, Cleveland, Ohio (JDS). The funding organization had no role in the design or conduct of the research.
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