Longitudinal Trends in Resource Utilization Associated With Newly Diagnosed Primary Angle Closure Glaucoma in the United States

PRÉCIS: The average cumulative 2-year cost following first primary angle closure glaucoma diagnosis was $2960. Elderly and Black patients were at higher risk of being among the costliest 5% (>$9813) of cases, accounting for 21.3% of costs. PURPOSE: To assess longitudinal eye care costs associated with newly diagnosed primary angle closure glaucoma (PACG) in the United States. METHODS: Patients with a diagnosis of PACG between 2009 and 2017 were identified in Optum's deidentified Clinformatics Data Mart Database based on International Classification of Diseases (ICD) codes. Newly diagnosed PACG was defined as: (1) diagnosis by an ophthalmologist or optometrist; (2) observable for at least 12 months before and 24 months after index diagnosis; (3) no prior history of glaucoma treatment; (4) PACG-related treatment initiated after index diagnosis. Logistic regression modeling was performed to identify risk factors for being in the top 5% of cumulative 2-year costs. RESULTS: Among 12,673 eligible patients, the average cumulative 2-year cost following first PACG diagnosis was $2960. Patient costs were highest in the 6 months immediately following diagnosis, accounting for 52.3% of all 2-year costs. 56.7% of all 2-year costs were related to treatment procedures. The costliest 5% (>$9813) of patients accounted for 21.3% of all 2-year PACG-related costs. Risk factors for being in the costliest 5% ( P <0.05) included older age, Black race, PPO or other Medicare insurance product, living in the Midwest or the South, and recent diagnosis of anatomic narrow angles (ANA). CONCLUSION: Costs associated with newly diagnosed PACG were found to be disproportionately driven by a small subset of cases. Elderly and Black patients were more likely to be within the top 5% of cumulative 2-year costs. Identifying and preventing the costliest PACG cases could reduce PACG-related eye care expenditures.