A Comparison of Resource Use and Costs of Caring for Patients With Exfoliation Syndrome Glaucoma Versus Primary Open-Angle Glaucoma

Purpose: To characterize differences in resource utilization and cost of managing enrollees with exfoliation glaucoma (XFG) compared to primary open-angle glaucoma (POAG). Design: Retrospective utilization and cost comparison using Medicare claims data. Methods: We identified Medicare beneficiaries with XFG or POAG and ≥5 years of continuous enrollment from January 2008 to December 2014. We distinguished newly diagnosed cases from those with preexisting disease. We compared ophthalmic resource utilization and costs over 2 years of follow-up for persons with newly diagnosed and preexisting XFG vs those with POAG. Main outcome measures were number of clinic visits, diagnostic procedures, medication fills, laser and incisional surgery, and mean eye care costs per beneficiary. Results: Among 192 eligible enrollees (median age 77.6 years) with newly diagnosed XFG and 7339 enrollees (median age 77.3 years) with newly diagnosed POAG, those with XFG had more office visits (mean, 9.1 vs 7.9; P =.001), cataract surgery (34.9% vs 19.0%; P <.0001), and glaucoma surgery (28.7% vs 19.7%, P =.002). They also experienced 27% higher mean total eye care costs ($3260 vs $2562, P =.0001) over 2 years of follow-up. Among 2745 enrollees (median age 80.5 years) with preexisting XFG and 89 036 persons (median age 79.5) with preexisting POAG, persons with XFG had more office visits (mean 9.3 vs 7.3; P <.0001), perimetry (85.3% vs 79.8%; P <.0001), cataract surgery (23.4% vs 12.3%; P <.0001), laser trabeculoplasty (18.6% vs 9.6%; P <.0001), and trabeculectomy (8.1 vs 1.8%; P <.0001) and experienced 37% higher total mean eye care costs ($3764 vs $2739; P <.0001). Conclusions: Healthcare resource utilization and costs are substantially higher for managing patients with XFG compared to POAG.