The Association of Socioeconomic Status with Severity of Glaucoma and the Impacts of Both Factors on the Costs of Glaucoma Medications: A Cross-Sectional Study in West Bengal, India.
The Association of Socioeconomic Status with Severity of Glaucoma and the Impacts of Both Factors on the Costs of Glaucoma Medications: A Cross-Sectional Study in West Bengal, India.
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DOI：
10.1089/jop.2017.0135
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发表时间：
2018-07
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影响因子：
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通讯作者：
Tutul Chakravarti
中科院分区：
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作者：
Tutul Chakravarti
目的 评估社会经济地位 (SES) 与青光眼严重程度的关联，并评估 SES 和疾病严重程度因素对印度西孟加拉邦不同青光眼亚型青光眼药物费用的影响。方法 这项横断面研究 (2014-16) 对 304 名原发性青光眼患者的治疗进行了至少 18 个月的随访。 0-3 阶段遵循基于视野的青光眼分期；视野<10°的患者被归类为第4阶段（末期）。我们仅检查了每位患者青光眼药物的平均成本，而不是“直接成本”。个人的月收入分为：低、中、高SES。结果 城市居住（比值比 [OR] 0.6，P < 0.009）、较高的 SES（OR 0.3，P < 0.001）和较高的认知度（近 50%，P < 0.007）显着降低了患终末期青光眼的几率。 69%的原发性闭角型青光眼（PACG）和79%的青少年开角型青光眼（JOAG）属于低SES，构成了终末期青光眼的大部分。除原发性开角型青光眼 (POAG) 外，所有亚型从 0 期到晚期的总体医疗费用都会上升。只有 28% 的低 SES 眼睛在疾病早期接受品牌药物治疗，这一比例在第 4 阶段也下降至 16%，而 57% 的较高 SES 眼睛在疾病早期使用品牌药物。在低 SES 中，JOAG 的支出占收入的百分比最高（16%），其次是 PACG（15%）和 POAG（14%）。结论 结果表明 SES 对西孟加拉邦的疾病结果、临床管理和青光眼药物费用有影响。青光眼的医疗费用随着疾病严重程度的恶化而增加；更多地使用仿制药并不总能确保直接节省成本。
PURPOSE To evaluate the association of socioeconomic status (SES) with severity of glaucoma and assess the impacts of both SES and disease-severity factors on the costs of glaucoma medications among different glaucoma subtypes in West Bengal, India. METHODS This cross-sectional study (2014-16) followed the treatment of 304 primary glaucoma patients for at least 18 months. The visual field based glaucoma staging was followed for stages 0-3; patients with field of vision <10° were categorized as stage 4 (end stage). We checked only the mean cost of glaucoma medications per patient and not "direct costs." The individuals' monthly incomes were classified into: low, moderate, and higher SES. RESULTS Urban residence (odds ratio [OR] 0.6, P < 0.009), higher SES (OR 0.3, P < 0.001), and higher awareness (nearly 50%, P < 0.007) significantly lowered the odds of having end-stage glaucoma. Sixty-nine percent primary angle-closure glaucoma (PACG) and 79% juvenile open-angle glaucoma (JOAG) belonged to low SES, forming the bulk of end-stage glaucoma. Overall medical cost from stage 0 to advanced stage in all subtypes rises except in primary open-angle glaucoma (POAG). Only 28% eyes from low SES were treated with branded drugs in early disease and that too declined to 16% in stage 4, while 57% higher SES used branded medications in early disease stage. Expenditure as a percent of income was the highest in JOAG (16%) followed by PACG (15%) and POAG (14%) among low SES. CONCLUSIONS Results indicate SES influences on disease outcome, the clinical management, and the glaucoma medication expenses in West Bengal. Medical costs of glaucoma increase with worsening disease severity; greater use of generic drugs does not always ensure direct cost savings.