Burden of Glaucoma in the United Kingdom A Multicenter Analysis of United Kingdom Glaucoma Services

Objective: To determine the spectrum of glaucoma-associated health care resource utilization among out-patients attending National Health Service (NHS) hospital glaucoma clinics and the costs of managing glaucoma in this setting. Design: Retrospective observational cohort study using electronic medical record data. Subjects: Patients aged > 18 years attending 5 NHS glaucoma clinics in the United Kingdom (2013-2018) with > 12 months of continuous electronic medical record data. Methods: Deidentified Medisoft Ophthalmology electronic medical record data (January 2013-December 2018) from 43 742 eligible patients were categorized by year of clinic visit. Extracted information included patient demographics, glaucoma diagnoses, topical glaucoma medication prescription start/stop dates, types/numbers of glaucoma clinic visits, glaucoma investigations (visual acuity, intraocular pressure, visual field, and OCT), and glaucoma procedures received over 12 months after the first ("index") visit of the specified year. Direct glaucoma-related health care costs (clinic visits, investigations, procedures, and ongoing glaucoma medication initiated in the clinic) were estimated from event volumes and unit costs (UK national tariffs) and expressed from the direct-payer perspective. Main Outcome Measures: Glaucoma diagnoses and topical glaucoma medication use at the index clinic visit; numbers of glaucoma clinic visits, investigations and procedures; and glaucoma-related health care costs over 12 months postindex. Results: For the 2016 cohort (n = 21 719), the estimated average total cost of NHS-provided glaucoma care over 12 months was & POUND;405 per patient (medical staff services & POUND;209, glaucoma investigations & POUND;126, glaucoma medication & POUND;40, glaucoma procedures & POUND;26). Among this cohort, 40.8% had ocular hypertension/suspected glau-coma, 70% had 0-to-mild visual field impairment, and 14% had undergone a glaucoma procedure. Over 12 months, patients received (mean) 2.0 glaucoma clinic visits and 1.5 visual field tests, and 7% underwent glaucoma procedure(s). Results were similar for the other years examined. Conclusions: Cost estimates for managing patients with glaucoma in the UK are required for effective service planning. Appreciable proportions of patients managed in NHS glaucoma clinics may be considered at low risk of blindness (glaucoma suspects and those with ocular hypertension with mild visual field loss) and may be more appropriately managed with alternative, more affordable models of care.