Hospital-based glaucoma clinics: what are the costs to patients?

Aim To investigate the costs to patients attending hospital-based glaucoma clinics. Methods A patient-based costs questionnaire was developed and completed for patients attending six ophthalmology units across London (Ealing General Hospital, St Georges Hospital, Mile End Hospital, Upney Centre Barking, St Ann's Hospital and the Royal London Hospital). The questionnaire considered age, sex, ethnicity as well as patient-based costs, opportunity costs, and companion costs. All patients visiting for review or appointments were approached non-selectively. A total of 100 patients were sampled from each unit. Results The mean age of the full sample was 69.6 years (SD 12.6), with little variation between sites (68.5-71.8 years). There was an almost equal sex distribution (male (298 (50.6%)). There was no major difference in occupational distribution between sites. The majority of people came to hospital by bus (40%) or car (26%). Female patients went slightly more by cab or car, whereas male patients went slightly more by foot or train. There was some variability in transport method by site. The data showed that the Royal London hospital had the highest mean cost per visit (16.20) pound, whereas St Georges had the lowest (12.90) pound. Upney had the second highest mean cost per visit (15.20) pound, whereas Ealing and St Ann's had similar mean costs of (13.25) pound and (13) pound, respectively. Travel costs accounted for about one-fifth of the total patient's costs. For all glaucoma clinics, total societal costs were higher than the sum of patients' costs because of the high frequency of companions. A surprising finding was that two-thirds of the population (392 or 66.6%) reported no qualification-considerably higher than the national census statistics for the same population. Conclusions To our knowledge this paper presents direct and indirect patient costs in attending hospital glaucoma units for the first time. It highlights the significance of opportunity costs when considering healthcare interventions as they amount to a third or more of the total costs of patient attendances to clinics. Eye (2010) 24, 999-1005; doi: 10.1038/eye.2009.284; published online 4 December 2009