Glaucoma Treatment Costs Outweigh Median Annual Household Income

Peter Zhao, MD

For patients with glaucoma, having access to long-term treatment is often vital due to the eye condition’s chronic nature, which can result in blindness if left untreated. However, expensive therapies can make it difficult for patients to maintain treatment over extended periods of time.

With recent research indicating that glaucoma treatment costs outweigh the median annual household income (MA-HHI) for many patients worldwide, investigators have recently deduced that making glaucoma interventions more affordable, among other contributing factors, is necessary for reducing global blindness caused by glaucoma.

Through a cross-sectional observational study, investigators—led by Peter Zhao, MD, of the Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan—compared the prices of 3 types of treatments: topical glaucoma medications (such as latanoprost and timolol), laser trabeculoplasty (LTP), and trabeculectomy. The treatments were compared relative with median annual household income (MA-HHI) from 38 countries worldwide.

Prices for these 3 types of treatments were obtained from each country using government pricing data, drug databases, physician fee schedules, academic publications, and communications with local ophthalmologists.

For purchasing power parity and inflation of 2016 US dollars, prices were adjusted. Relative to MA-HHI, annual therapy prices were assessed. Investigators deemed interventions that cost less 2.5% of the MA-HHI to be affordable.

From the data collected, which included 17 developed countries and 21 developing countries according to the World Economic Outlook, a significant range in prices were observed. Across the countries and across interventions, intervention prices were recorded to contain considerable variability compared with MA-HHI.

For timolol, costs ranged from .1% to 5% of MA-HHI; for latanoprost, .1% to 27%; laser trabeculoplasty, .2% to 17%; and for trabeculectomy, .3% to 42%. Observed as the most affordable treatment in all the countries evaluated, timolol was 2.5% or more of MA-HHI in only 2 countries (5%).

In 15 countries (41%), latanoprost was 2.5% or more of MA-HHI, which included 15 developing countries (75%) and no developed countries. In 15 countries (44%) that included 11 developing countries (65%) and 4 developed countries (24%), the cost of LTP was 2.5% more of the MA-HHI. Additionally, LTP cost less than a 3-year latanoprost supply in 18 countries (53%).

The most expensive treatment in 28 countries (78%)—18 developing countries and 10 developed countries—trabeculectomy was 2.5% or more of the MA-HHI.

From their gleaned data, investigators concluded that the costs of medical, laser, and surgical interventions were 2.5% or more of the MA-HHI for many patients worldwide.

However, in a commentary regarding the study, Dana M. Blumberg, MD, PhD, pointed to the need for defining affordability.

“As the authors point out, there is no universally accepted threshold for affordability,” Blumberg wrote. “By extension, defining affordability of medical treatment is challenging because it is difficult to capture and measure.”

Blumberg emphasized that future studies should assess treatment availability due to currently few existing data on whether glaucoma patients in low- and middle-income countries gave access to affordable treatments. In her opinion, the organization of the pharmaceutical sector infrastructure should be considered by availability studies since this data impacts drug pricing.

The study, "A Worldwide Price Comparison of Glaucoma Medications, Laser Trabeculoplasty, and Trabeculectomy Surgery," was published online in JAMA Ophthalmology.