The Cost of Glaucoma Care Provided to Medicare Beneficiaries from 2002 to 2009

Purpose: To estimate payments for glaucoma care among Medicare beneficiaries from 2002 to 2009. Design: Database study. Participants: Data from a 5% random sample of Medicare billing information from 2002 to 2009. Methods: Medicare beneficiaries, aged 65 years or older, with both Parts A and B fee-for-service (FFS) enrollment comprised the annual denominator. For each year, we included those with a defined glaucoma diagnostic code linked to a glaucoma visit, diagnostic test, or laser/ surgical procedure. Open-angle, angleclosure, and other glaucoma were categorized separately. Claims were classified into glaucoma care, other eye care, and other medical care. Main Outcome Measures: Cost of glaucoma care in the Medicare Fee-for-Service Population. Results: In 2009, total glaucoma payments by Medicare were $ 37.4 million for this subset, for an overall estimated cost of $ 748 million, or 0.4% of an estimated cost of $ 192 billion for all Medicare FFS payments. Office visits comprised approximately one half, diagnostic testing was approximately one-third, and surgical and laser procedures were approximately 10% of glaucoma-related costs. Coded open-angle glaucoma (OAG) and OAG suspects accounted for 87.5% of glaucoma costs, whereas cost per person was highest in "other glaucoma."In 2009, < 3% of patients with OAG underwent incisional surgery and approximately 5% had laser trabeculoplasty. Laser iridotomy was the highest cost category among patients with angle-closure glaucoma, whereas office visits was the highest cost category among the "other glaucoma"group. The total cost of nonglaucoma eye care for patients with glaucoma was 67% higher than their glaucoma care costs; these were chiefly costs for cataract surgery and treatment of retinal diseases. From 2002 to 2009, FFS glaucoma care costs calculated in 2009 dollars were stable and cost per person per year in 2009 dollars decreased from $ 242 to $ 228 (P=0.01 by test for linear trend). Conclusions: Annual glaucoma care costs per person decreased in constant dollars from 2002 to 2009. Cataract and retinal eye care for patients with glaucoma substantially exceeded the cost of their glaucoma care each year. Visit payments represented the largest category of costs.