Predictors, Resource Utilization, and Short-term Costs of Laser Trabeculoplasty Versus Medication Management in Open-Angle Glaucoma

Abstract

Adjunctive laser trabeculoplasty (LT) is an alternative to topical medications for open-angle glaucoma (OAG). The purpose was to: (1) identify predictors of LT vs glaucoma medication treatment; and (2) estimate the resource utilization and short-term costs associated with LT vs medication management. Retrospective administrative claims analysis. Medical and pharmacy claims data between 2007 and 2012 were analyzed to identify prostaglandin analogue monotherapy OAG patients with an index date LT claim or second medication class claim. Patientswere followed for 12months pre-index and 24months post-index. Predictive LT attributes included age, sex, employment status, medication adherence, comorbidity status, and geographic region. Short-term costs included glaucoma-specific and comprehensive healthcare encounters. Cohort comparisons were analyzed using χ(2) and Student t tests, logistic regression (predictive), and generalized linear models (cost). The study included 4743 LT and 16 484medication patients. Baseline demographics were similar but significant differences were identified for comorbidities, adherence, and geography. Younger age (odds ratio [OR]: 1.21; P < .001), low adherence (OR: 1.18; P= .001), high comorbidities (OR: 1.12; P= .006), and region (OR: 1.50; P < .001) significantly predicted LT receipt. Within LT patients, 60% did not have a pharmacy claim 45days post-index; by 2 years, this reduced to 20%. LT attributed significantly higher medical ($2684 vs $1980; P < .0001), lower pharmacy ($807 vs $1467; P < .0001), and greater overall costs ($3441 vs $3408; P= .325). Poor adherence, younger age, and more comorbidities were predictors of receiving LT. Despite the potential for LT to address adherence, most patients had a medication claim within 2 years. Overall, LT does not provide glaucoma-specific cost savings.