Procedures Drive Costs for Newly Diagnosed PACG

Eye care costs of PACG patients with either a recent or established diagnosis anatomically narrow angles were higher after PACG diagnosis. Less surprisingly, eye care costs were also higher for these patients the year before PACG diagnosis. Photo: Alison Bozung, OD. Click image to enlarge. While there is some data on costs associated with different treatments for primary angle-closure glaucoma (PACG), there is sparse knowledge about eye care expenses associated with newly diagnosed cases. Researchers based in Southern California assessed longitudinal eye care costs associated with newly diagnosed PACG in the United States.Among 12,673 eligible patients, the average cumulative two-year cost following the patient’s first PACG diagnosis was $2,960. Patient costs were highest in the six months immediately following diagnosis, accounting for 52.3% of all two-year costs. Notably, 56.7% of all two-year costs were related to treatment procedures. The researchers’ logistic regression analysis revealed several disparities among PACG patients in the costliest 5% group, which comprised 21.3% of total eye care costs. Among these disparities, Black patients had 1.53-times higher odds of being in the most expensive group compared with non-Hispanic white patients.“Recent findings on racial disparities in the detection, treatment and cost of PACG in the US support the need for additional research to identify the underlying cause of these disparities and develop novel objective methods to risk-stratify patients for PACG,” the researchers wrote in their paper.Using a database of deidentified administrative health claims data warehouse of commercial and Medicare Advantage health claims, this study, which was published in Journal of Glaucoma, analyzed the average two-year cost in inflation-adjusted 2020 USD of newly diagnosed PACG in the United States from 2009 to 2017.Patients with a prior diagnosis of anatomic narrow angles (ANA) were divided into two groups: those with a PACG diagnosis within six months of first ANA diagnosis (recent ANA) and those with PACG after six months of first ANA diagnosis (established ANA). This distinction was made to separate out patients who already had PACG at the time of first ANA diagnosis but experienced delays in diagnosis (e.g., due to lack of diagnostic testing).The study noted that patients with a recent or established diagnosis of ANA before diagnosis of PACG incurred significantly higher costs compared with patients without a prior diagnosis of narrow angles, both in the year before diagnosis and two years after diagnosis.Other factors conferring a higher risk of being in the costliest 5% group in the US included older age, PPO or other Medicare insurance products, as well as location in the Midwest or South geographic regions. The researchers found that types of Medicare insurance products remained a significant predictor of being in the costliest 5% group, which could indicate easier access to PACG-related procedures compared with patients with commercial HMOs.“Older age is a risk factor for both cataracts and PACG,” the researchers wrote. “Therefore, it is intuitive that older patients with PACG are more likely to have visually significant cataracts and receive lens extraction as a primary treatment.The study also revealed aspects of current practice patterns that may have implications for recommendations regarding PACG management. In the two years after the initial PACG diagnosis, LPI was the most common procedure (37.4% of the cohort), followed by lens extraction (22.9% of the cohort). However, among patients who underwent lens extraction at any time in our sample or lookback period, 41.1% received at least one LPI within the preceding two years.“Although our study provides novel insights into costs and practice patterns associated with newly diagnosed PACG, further research on methods to improve the precision of angle closure care and the cost-effectiveness of personalized PACG treatments is needed,” the authors concluded.Click here for the journal source. Guth D, Apolo G, Seabury SA, et al. Longitudinal trends in resource utilization associated with newly diagnosed primary angle closure glaucoma in the United States. J Glaucoma 2025; 34(10):776-82. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.