Glaucoma costs in Denmark in treatment naive patients

Introduction

Primary open angle glaucoma(POAG) is the most common form ofglaucoma. It is a chronic disease thatreduces the visual field over a periodof years. It can lead to progressiveoptic nerve degeneration and blind-ness (Distelhorst & Hughes 2003). Its

prevalence rate above age 40 yearsvaries between 1% and 5% andincreases with age (Ekstrom 1996; deVoogd et al. 2005). Additional riskfactors are high intra-ocular pressure(IOP) (Le et al. 2003), family history,diabetes mellitus, race, hypertensionor hypotension, severe myopia and ahistory of severe ocular trauma (Mar-

tin et al. 1985; Tielsch et al. 1994;Dielemans et al. 1995, 1996).

The Ocular Hypertension Treat-ment Study (Kass et al. 2002) showedthat topical ocular hypotensive medi-cation delays or prevents the onset ofPOAG. In the Advanced GlaucomaIntervention Study (AGIS 2000),mean visual field defect scores, mea-sured at every visit during a 6-yeartreatment follow-up period, decreasedto almost zero in eyes with IOP values<18 mmHg.

Economic studies of glaucoma andocular hypertension (OHT) have beenperformed in Nordic countries. In thelate 1990s, Kobelt-Nguyen et al. 1998estimated treatment costs in Swedenat $2160 during the two-first yearsafter diagnosis. The model used byKobelt & Jonsson (1999) suggestedthat the greater effectiveness of pros-taglandin analogues for IOP controlcould delay the use of rescue treat-ments (laser and surgery). A study byDenis et al. (2004) showed thatchanges of treatment regime increasedcosts. During recent decades, the con-sumption of anti-glaucoma drugs hasincreased steadily in Nordic countries.The cost increase can be explained inpart by the use of newer more expen-sive drugs. Supplementary use of suchdrugs is more common than changesto new therapy. A recent study byThygesen et al.(2008) estimated socialand health care maintenance costs oflate-stage POAG in Denmark, but thepatient sample was small (n = 59). Itfound that late-stage glaucoma isassociated with home-help costs that

Glaucoma costs in Denmark intreatment naive patients

Jens Olsen,1 Gilles Berdeaux,2,3 and Jesper Skov4

1Centre for Applied Health Services Research and Technology Assessment,University of Denmark, Odense C, Denmark2Alcon France, Rueil-Malmaison, France3National Conservatory of Arts and Trades, Paris, France4Eye clinic, Fredericia, Denmark

ABSTRACT.

Purpose: To describe the costs and providers of glaucoma treatment in Den-

mark.

Methods: Analyses were based on National Register data. Glaucoma ⁄OHT

patients were identified by their first prescription for glaucoma medication

(ATC-codes) in the Danish Register of Medicinal Product Statistics 2002–

2007. Patients had used no glaucoma medication for 6 months. Data for 2007

were sampled cross-sectionally for a budgetary analysis of glaucoma (ICD10

code) medication and services consumed in the primary and secondary health

care services. Patients were categorized according to their number of treat-

ment changes.

Results: The Danish annual incidence rate of glaucoma was estimated at 1.2

per 1000 adult persons. Thirty-seven per cent of patients (men 44%, mean age

68 years; women 56%, mean age 71 years) persisted with their initial treat-

ment regimen, 21% had changed to a second regimen, and 43% had experi-

enced ‡3 regimens. Treatment costs increased with the number of sequential

regimens. Annual glaucoma costs (health care sector perspective) were €305for patients under their initial regimen, increasing to €740 with ‡3 regimens.

Drug costs accounted for 57% of total cost.

Conclusions: Drugs represented the major cost of glaucoma, and those costs

increased, obviously, with the number of treatment changes.

Key words: budget – costs – economics – glaucoma – ocular hypertension

Acta Ophthalmol.ª 2011 The Authors

Acta Ophthalmologica ª 2011 Acta Ophthalmologica Scandinavica Foundation

doi: 10.1111/j.1755-3768.2011.02212.x

Acta Ophthalmologica 2011

1

are higher than health care mainte-nance costs, suggesting that betterpreventative treatment could producepotential savings for social care pay-ers, in contrast to health care payers.

Knowledge of treatment costs isimportant for health care decision-makers. The use of models to evaluatethe cost-effectiveness of glaucomatherapy is increasing (Nordmann et al.2005, 2009; Denis et al. 2008a)because it is difficult to documentlong-term effectiveness and costs (e.g.prevention of blindness) from patientdata. However, economic models needsubgroup analysis information on thecosts of glaucoma and on patientslikely to incur the greatest costs.

Denmark has some specificities interms of funding and delivering healthcare. Health care provision (primaryand secondary care) in Denmark is toa great extent a public task, as 85%.of health care costs are financedthrough taxes. Health care is mainlyprovided by the regional authorities.There is free and equal access for allDanish citizens. The patients faceco-payment for prescription drugs,dentist services and visits at physio-therapists, chiropractors, etc. Theextended choice of hospitals entitlespatients – free of charge – to treatmentat a private hospital in Denmark orabroad that has entered an agreementwith the Danish regional authorities.The treatment is at the expense of theregion where the patient is residing.

The purpose of this study was toestimate the costs of glaucoma in Den-mark (health care sector perspective),i.e. costs to the primary and secondaryhealth care sectors, including medi-cines prescribed for glaucoma ⁄OHT.The study applies an incidenceapproach, that is it is only the cost ofnew patients (naıve glaucoma ⁄OHTpatients) which is estimated.

Methods

The analyses were based on dataextracted from National Registers (da-tabases) where each individual patientis identified by a unique registrationnumber (CPR-No.). The Danish healthservice has a long tradition of record-ing health service provisions. EveryDanish citizen’s contact with the pri-mary health care sector (general practi-tioner, public and private specialist,ophthalmologist, dentist, physiothera-

pist, chiropractor, etc.) and secondaryhealth care sector (hospital outpatientvisits, admissions, etc.) is exhaustivelyrecorded in these registers, i.e. sex, age,type of contact, speciality, fee ⁄ charge,diagnoses (secondary health care sectoronly) and procedure codes. Danish leg-islation permits researchers and othersto access the databases. This study wasreported to, and approved by, theDanish Data Protection Agency (J.No.2008-41-2563). Data for 2007 weresampled cross-sectionally to estimateannual glaucoma ⁄OHT costs and per-form a budgetary analysis. The analy-sis embraced medicines and services inthe primary and secondary health caresectors relevant to glaucoma.

Glaucoma ⁄OHT patients were iden-tified by prescribed glaucoma medica-tion (defined by ATC-codes – S01Eclass) listed in the Danish Register ofMedicinal Product Statistics (2002–2007). The focus was on naive glau-coma ⁄OHT patients, i.e. patients notpreviously treated with an intraocularpressure (IOP)-lowering drug. A newor incident patient was one who hadnot used glaucoma medicines in theprevious 6 months, because treatmentis delivered usually for 3 months. This6-month delay has often been used toidentify naive to IOP treatmentpatients (Schmier et al. 2009; Schmier& Covert 2010) when analysing data-base. Accordingly, the study estimatedthe number of new patients over5.5 years (mid-2002 to 2007) to ensurethat eligible patients had begun glau-coma medication during the observa-tion period. Costs of glaucomamedication were taken from the Dan-ish Register of Medicinal Product Sta-tistics, 2007. Market prices were usedas cost estimates.

Data on primary health care ser-vices relating to glaucoma treatment,e.g. treatments and examinations,were extracted from the Primary CareSector Register (Sygesikringsregister-et), accessed by the patient’s uniqueregistration number. Such services areassociated with fees paid by the publichealth insurance system to the pro-vider. Fees can be regarded as costestimates, reflecting the value of a ser-vice (Honorartabel 2007).

Data on the patients’ resource use inthe secondary care sector (the hospitalsector) were obtained in the NationalPatient Register (Landspatientregisteret)via the unique person registration

number and were defined in terms ofregistered hospital contacts. A contactcan take place as a visit at the accidentand emergency department, an outpa-tient clinic or as an inpatient admis-sion. For each contact, there is adescription of the resource use associ-ated with the contact, which is definedaccording to the national diagnosticrelated group system (DRG-system).That is, the DRG-charges were usedas cost estimates (Sundhedsstyrelsen2007). In this analysis, only servicesrelated to the treatment of Glaucomawere included, implying that only con-tacts where the primary diagnose wasa ‘Glaucoma-diagnose’ were included(‘Glaucoma-diagnose’ defined as rele-vant ICD10-diagnosis codes). The costestimates were converted from DKKto € using the following exchange rate:7.44 DKK = 1.00€.

The present data, based on theabove three registers, categorizedpatients according to their number oftreatment changes. Treatment changewas defined as the start or cessation(duration at least 180 days) of a glau-coma treatment (including laser treat-ment and surgery). A 180-day or moretime wise gap between two purchasesof the same glaucoma medicine wasalso categorized as a treatment change.Data were analysed with SAS software(SAS Institute Inc., Cary, NC, USA).Descriptive statistics (mean, medianand 95% confidence intervals) wereapplied to qualitative variables. Multi-ple linear stepwise regression analysis,with log transformation of skewedcost distributions, was used to identifyfactors that predicted total annualhealth care costs and annual drugcosts. Average costs per patient(regression barycentre) were calculatedfrom the model’s estimators. Costs perpatient served as a reference to esti-mate additional costs by varying rele-vant factors (explanatory variables).

Results

A total of 27 380 new glaucoma ⁄OHTpatients were identified for the5.5-year period (mid-2002 to 2007),corresponding to a yearly incidence rateof 0.91 per 1000 people or 1.2 per 1000adult (+17 years) persons (Danishpopulation: 5.4 million, Danish adult(+17 years) population: 4.2 million).

The patient population was com-prised of 44% men (mean age


2

68 years) and 56% women (mean age71 years). Thirty-seven per cent ofpatients continued with their initialtreatment; 21% had transferred to asecond regimen; and 43% had experi-enced ‡3 treatment regimens. Table 1presents patient demographic andtreatment statistics. It can be seen thatthe frequency of treatment changesgradually increased with the numberof years since first diagnosis.

Figure 1 further shows that glau-coma treatment costs increased withthe number of treatment changes.Total annual glaucoma costs perpatient averaged €305 during initialtreatment, but increased to €740 forpatients experiencing ‡3 treatmentchanges. On average, drugs accountedfor 57% of total costs, but as totalcosts increased, the drug contributiondecreased from 61% during initialtreatment to 51% with ‡3 treatmentchanges.

Table 2 shows cost estimates for theprimary health care sector (privateophthalmologists). Visits to ophthal-mologists during the year increasedwith the frequency of treatmentchanges. Consequently, costs increasedfrom €110 to €239 with ‡3 treatmentchanges. It should be stated that26.3% of patients receiving first-linetreatment did not visit any ophthal-mologist registered in the primaryhealth care database.

Moreover, few patients (1.3–6.3%)sought hospital care for glaucoma(Table 3). Hence, annual mean costsin the secondary health care sectorwere low, but increased once againwith the number of treatment changes(€8–€123). If only patients with con-tact to the hospital sector areincluded, the annual mean costs wereestimated to € 1500 – ranging from €622 (0 treatment changes) to € 1966(three or more treatment changes).

Glaucoma treatments and regimenchanges are presented in Table 4.More than 50% of patients (increas-ing with treatment changes) were pre-scribed prostaglandin analogues. Also,the percentage of patients receivingfixed combinations (especially prosta-glandin analogue agents plus timolol)increased with the number of changes.Note that most patients started withmonotherapy with only 11.7% receiv-ing combination treatments.

Table 5 summarizes regression anal-ysis results, i.e. factors predicting total

health care costs and drug costs, respec-tively. The model explained 25% and26% of the cost variances (R2-values),and estimated average annual totalpatient costs were €369. The datacharacterized the average patient as a

woman aged 71 years, treated for2.4 years with one treatment change.Differences of gender contributed littleto cost variation. By contrast, age,the number of regimen changes andespecially years of treatment (disease

Table 1. Descriptive statistics: number of glaucoma patients, number of treatment changes, age

and duration of treatment.

Treatment changes and

gender Patients

Treatment duration

(years)

Gender

No. treatment

changes N

Age

Mean MedianMean Median

Male 0 4420 67.0 69 1.98 1.49

1 2443 68.9 70 2.48 2.23

2 1829 69.2 70 2.36 2.14

‡3 3347 68.2 70 2.93 2.99

Female 0 5578 70.6 73 2.07 1.66

1 3185 71.6 73 2.54 2.36

2 2419 71.3 73 2.38 2.18

‡3 4159 70.6 72 2.91 2.99

Table 2. Costs p.a. incurred by the primary care sector resulting from treatment changes (2007

prices)*.

Treatments Patients Costs (€)

No. changes N

% visiting

ophthalmologists

in 2007 [% (n)] Mean Median

CI 95%:

mean

lower limit

CI 95%:

mean

upper limit

0 9998 73.7 (7367) 110 84 106 114

1 5628 91.4 (5146) 155 132 150 159

2 4248 92.9 (3.945) 185 154 179 191

‡3 7506 93.9 (7.047) 239 189 233 243

* Primary health care sector costs include visits, examinations, laser treatment and surgery.

€ 187

€ 278 € 295

€ 382

€ 305

€ 451

€ 507

€ 744

0

100

200

300

400

500

600

700

800

Cos

t (€)

1st 2nd 3rd 3 or more

Treatment sequence

Drug costTotal cost

Fig. 1. Average glaucoma treatment costs p.a. according to treatment changes (2007 prices).


3

duration) contributed substantially toincreasing costs.

The number of treated patients in2007 was 27 380 (corresponding to thenumber of new patients over 5.5 years –mid-2002 to 2007), and the total treat-ment costs for these glaucoma ⁄OHTpatients were estimated €13.3 millionp.a. (2007 prices). A budget impactanalysis (costs distribution) betweendrugs, primary and secondary (hospi-tal) health care sectors is shown inFig. 2.

The foregoing cost analyses adoptedthe health care sector perspective, sig-nifying that all costs (except for

drugs) were publicly funded (taxes) inDenmark, i.e. primary and secondaryhealth care sector costs. A co-paymentscheme exists for prescription drugs,i.e. for payments between €0 and €110a year, patients bear all drug coststhemselves; from €110 to €180, theybear 50% of costs; from €180 to €390,the co-payment is 25%; and with drugcosts greater than €390 p.a., they bear15%. The results show annual meandrug costs per patient after paying€187 for first-line treatment, €278 forsecond-line treatment, €295 for third-line treatment and €382 for fourth-lineand subsequent treatments. Hence, all

glaucoma ⁄OHT patients made annulco-payments of at least €145. If apatient is treated with other prescrip-tion medicines within the same yearin addition to glaucoma drugs, theco-payment for glaucoma treatmentmay be reduced.

Discussion

To our knowledge, this is the firstreport of glaucoma costs and factorspredicting costs to be based onnational registers collecting compre-hensive patient data of an entire coun-try. In 2007, when life expectancy wasapproximately 78 years (2005), theDanish health care sector disbursed,in total, about 16 billion euros mostlyon the primary health care sector,medicines and care in a population of5.4 million inhabitants. Today, onreaching an average age of 69.5 years,about 5000 Danish citizens p.a. willbegin glaucoma treatment. They willthen be treated for approximately10 years (OECD 2007). Thus, mostannual glaucoma expenditure is onexisting patients as opposed to naive,newly diagnosed patients startingIOP-lowering treatment.

As stated, this study applied anincidence approach implying that onlynew glaucoma ⁄OHT patients for a5.5-year period (mid-2002 to 2007)were included, thus ignoring patientsthat were already in treatment forglaucoma before mid-2002. If apatient on average is treated for glau-coma 10–12 years, then the total num-ber of patients in Denmark isapproximately 56 000 and the totalcost of glaucoma (health care sectorperspective) would be approximately€26.6 million p.a. (2007 prices), pro-vided the cost structure we estimatedremains constant over years.

Cost or budget comparisons amongcountries are not straightforward

Table 4. Drugs and treatment changes.

Medication

No. treatment changes

0 1 2 ‡3

ATC group

% patients

treated (%)

Sympathomimetics 1.6 3.1 4.0 12.4

Parasympathomimetics 1.5 1.5 1.2 2.2

Carbonic anhydrase inhibitors 19.1 14.6 17.8 27.2

Beta-blocking agents 20.1 24.4 22.3 25.6

Fixed combinations 9.4 24.9 27.3 41.4

Prostaglandin analogues 50.8 62.2 64.3 71.0

% patients given monotherapy* 88.3 45.9 43.1 5.1

* Column totals >100% as some patients were treated with more than one drug.

Table 3. Secondary health care sector (hospital) costs p.a. according to treatment changes

(2007 prices)*.

Treatments Patients Costs (€)

No. changes N

% patients

attending

hospital in

2007 [% (n)] Mean

CI 95% mean

lower limit

CI 95% mean

upper limit

0 9998 1.3 (129) 8.02 6.21 9.84

1 5628 2.1 (119) 18.40 11.46 25.33

2 4248 2.3 (96) 26.57 17.26 35.88

‡3 7506 6.3 (471) 123.34 103.91 142.77

* Costs include outpatient treatments and admissions. N.B. Patients not using hospital services

are included in the cost estimates.

Table 5. Factors predicting total annual health care costs and annual drug costs (2007 prices).

Item

Average

patient profile Model change

Total health

care costs* (€) p-value Drug costs� (€) p-value

Cost variance (R2) 0.2505 0.2648

Average patient costs 369 199

Treatment status 2 Changed 2–3 +74 <0.0001 +30 <0.0001

Sex Female Male )8 0.0381 )4 0.0409

Age (years) 71 >10 +59 <0.0001 +33 <0.0001

Treatment duration (years) 2.4 >5 +133 <0.0001 +299 <0.0001

* Regression model: ln(total healthcare costs + 1) = a + b1Æage + b2Æsex + b3Ætreatment years + b4ÆNo. treatment changes.

� Regression model: ln(drug costs + 1) = a + b1Æage + b2Æsex + b3Ætreatment years + b4ÆNo. treatment changes.


4

(Shaarawy et al. 2009a, Vol. 1)because the methods applied to getsuch estimates are highly variable(economic perspective, type ofresources collected, loss of productiv-ity included or not, unit cost, type ofexperimental design to guaranteenational extrapolation, etc.). A studysimilar to ours was conducted by Tuu-lonen (Vaahtoranta-Lehtonen et al.2007; Tuulonen et al. 2009) who esti-mated IOP-lowering drug incidenceand prevalence rates from the SocialInsurance Institution registers. Theyidentified 4895 naive patients over apopulation of 5.2 millions inhabitants,leading to an incidence rate of0.94 ⁄ 1000, a figure very close to ours(0.91). In terms of annual budgetcomparison, and even we applied araw method to account for the factthat we selected incident cases whilebudget estimates usually require pre-valent case, our estimate is similar tothe one reported in the literature.According to Taylor et al. (2006), theannual budget for glaucoma was144.2 millions Australian dollars(102.3 millions Euro) for 21.017 mil-lions inhabitants, which makes 26.6millions Euro when adjusted to theDanish population size. Our figureshould be interpreted as higherbecause Taylor included loss of pro-ductivity cost. Rein et al. (2006) did asimilar work in the USA, startingfrom claims collected in a privateinsurance and Medicare. They founda glaucoma budget of 2858 millions

US$ (2199 millions Euros) that couldbe estimated to 39.8 millions Eurosaccounting for the Danish populationsize. The fact that USA budget washigher is related to higher unit cost(e.g. drugs are more expensive) andthe inclusion of both loss of produc-tivity and nonmedical costs thataccounted up to 54% of the burdenof visual disorders.

According to Mukesh et al. (2002),there are few reliable data availableon the incidence of open-angle glau-coma from population-based studiesas well as the occurrence varybetween, e.g. Western populations andAfrican populations. However, theincidence rates reported in population-based studies are constantly higherthan the one we found. Ekstrom(2008) found that a rate of 7.11 ⁄1000in a 65- to 74-year-old population inSweden and Astrom et al. (2007)reported a similar estimate, 9 ⁄ 1000 ina 66+ Swedish population. These fig-ures are similar to the ones reportedin surveys conducted outside the Scan-dinavian area. For example, Leskeet al. (2007) and Mukesh (2002)reported incidence rates of 5 ⁄ 1000,respectively, in the Barbados islandsand Australia. Indeed, incident casesof treated glaucoma in Denmark rep-resent probably about one-third ofnew glaucoma, meaning that most ofthe new glaucoma patients are notdiagnosed. While this is probablyexplained by the insidious evolutionof glaucoma, especially at its begin-

ning, additional resources might beworth being invested to diagnosePOAG at this early stage to preservepatient visual functioning potential.Lastly, undiagnosed POAG has beenreported consistently in several Wes-tern developed countries [e.g. Antonet al. (2004), Topouzis et al. (2008),Wong et al. (2004)], which remainsone of the vision-related public healthissues.

Funds dedicated to glaucomashould be compared to other nationalhealth care costs. Thus, in 2005, Den-mark spent about €16.0 billion on itshealth care system: €5.7 billion onhospitals and €944 million on drugs(OECD 2007). It is, therefore, obviousthat glaucoma care, the second causeof blindness in developed countries,represents a small proportion of thebudget allocated to the Danish healthcare system.

We found that in Denmark, themost often prescribed drug was aprostaglandin analogue (PGA), what-ever the treatment line. The use ofPGA is one of the major drivers ofthe increase in drug cost in the lastyears (Shaarawy et al. 2009b, Vol. 2),and the profile of PGA prescription inDenmark was comparable to UK,France and Spain (De Natale et al.2011).

Drugs represent the major costs ofglaucoma, but their relative impor-tance decreases as treatments arechanged. This situation might changedramatically when PGA will becomegeneric. Outpatient and inpatientresources increase steeply with treat-ment changes: more treatment changesmore costs. This suggests that in thelong term, a longer treatment persis-tency might reduce (postpone) thecosts of glaucoma care, at least theones related to laser and surgery.Greater compliance on the part ofpatients would help to maximize treat-ment persistency without increasingcosts and needs to be considered forthe future. Also, a positive associationbetween PGA medication and fewerinterventions by laser therapy and fil-tering surgery is well documented at apopulation level (Bateman et al. 2002;Baudouin et al. 2003; Strutton & Walt2004; Walland 2004; Linksvan derValk et al. 2005; Long & O’Brien2005; Rouland et al. 2005; Knox et al.2006; Macleod et al. 2006; Rachmielet al. 2006; Kenigsberg 2007). Thus,

€ 1 855 42914%

€ 671 6105%

€ 519 9274%

€ 1 503 64611%

€ 1 222 3789%

€ 7 552 96657%

Primary care sector, visitsPrimary care sector, laserPrimary care sector, surgeryPrimary care sector, examinationsHospital sectorDrug cost

Fig. 2. Budget impact analysis.


5

the apparently high cost of drugstoday might result, at least partially,from cost-shifting from hospitals tothe drug budget, which will disappearonce PGA will become generic.Lastly, in the short term (at a treat-ment line–level duration), longer per-sistency (i.e. less treatment changes)has been found associated with costsavings according to daily practice, ontreatment, in- and outpatient careresource utilization (Lafuma & Ber-deaux 2007, 2008; Lafuma et al. 2008;Denis et al. 2008b; De Natale et al.2009; J. Salmon et al. 2011).

It is traditional in Denmark torecord the costs of health care servicesin central administrative databases.The registers contain fully comprehen-sive data and, in contrast to othercountries, provide a new and valuablecontribution to glaucoma cost studies.This study was based on individualregister data and included every newDanish glaucoma ⁄OHT patient for a5.5-year period (i.e. incident cases).Our results are consistent with reportsin the literature. Costs increase withage, treatment changes and diseaseduration. In this paper, we report esti-mates specific to Denmark. Fewpatients were treated in hospitals (athigher cost) where expensive proce-dures are undertaken that are notavailable in the primary health caresector. Furthermore, hospital treat-ment of ambulant patients is generallymore costly than that in primaryhealth care, because hospitals havehigher fixed costs.

Our analysis suffers from severallimitations. First, prescription renewalwas not clearly documented, so wefixed the average renewal periodempirically at 100 days (correspondingto three eye-drop bottles). Accordingto the summaries of most IOP-lower-ing drugs, an eye-drop bottle containsenough fluid for at least 28 days. Sec-ond, reasons for modifying treatmentswere not documented in the data-bases, thus precluding definitive analy-sis. We need such data to understandand deal with the reasons for treat-ment changes. Third, an unavoidablelimitation to the study was its retro-spective design, preventing verificationof data accuracy. For example, visitsfor monitoring disease progressionmight have been underreported,explaining why 26.3% of first-linepatients did not visit their ophthal-

mologists in 2007. Fourth, we did nothave access to IOP, visual field defectand other measures used in following-up glaucoma ⁄OHT patients. Access tosuch data would probably haveimproved our ability to identify thosepatients incurring high costs. Fifth, byits nature, a particular health caredatabase limited our economic per-spective on glaucoma costs incurredby the most advanced cases, i.e. con-cerning the economic impact of blind-ness, which is very important forfamilies as it leads to dramatic loss ofproductivity (Lafuma et al. 2006).Fifth, patients with glaucoma not cur-rently treated with an IOP-loweringdrug did not participate in this analy-sis (e.g. a naive patient with glaucomafiltering surgery whose IOP control issuccessful without glaucoma progres-sion).

In conclusion, the total costs of treat-ing 27 380 glaucoma ⁄OHT patientswere estimated €13.3 million p.a.(2007 prices). Costs increased withage, disease progression and treatmentfailure.

Acknowledgements

The results of this manuscript werepresented at the ISPOR (InternationalSociety for PharmacoEconomics andOutcome Research) European Con-gress, Paris, November 2009. Thiswork was financed by a grant fromAlcon. The analysis was conducted atthe Centre for Applied Health Ser-vices Research and TechnologyAssessment. Gilles Berdeaux isemployed by Alcon France.

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Received on April 22nd, 2010.

Accepted on May 11th, 2011.

Correspondence:

Gilles Berdeaux, MD

Alcon France

4, rue Henri Sainte-Claire Deville

F-92563 Rueil-Malmaison

France

Tel: + 33 1 47 10 48 60

Fax: + 33 1 47 10 27 70

Email: [email protected]


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Glaucoma costs in Denmark in treatment naive patients

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