The Cost of Glaucoma Care Provided to Medicare Beneficiaries from 2002 to 2009
The Cost of Glaucoma Care Provided to Medicare Beneficiaries from 2002 to 2009
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DOI：
10.1016/j.ophtha.2013.04.027
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发表时间：
2013-11-01
期刊：
影响因子：
13.7
通讯作者：
Friedman, David S.
中科院分区：
文献类型：
--
作者：
Quigley, Harry A.;Cassard, Sandra D.;Friedman, David S.
目的：估计2002-2009年医疗保险受益人的青光眼治疗费用。设计：数据库研究。参与者：数据来自2002年至2009年5%的随机抽样的联邦医疗保险账单信息。方法：联邦医疗保险受益人，年龄在65岁或以上，A部分和B部分均为服务费(FFS)投保人，构成年度分母。对于每一年，我们都包括那些具有与青光眼就诊、诊断测试或激光/外科手术相关的青光眼诊断代码的患者。开角型青光眼、闭角型青光眼和其他青光眼分别归类。索赔分为青光眼护理、其他眼睛护理和其他医疗护理。主要结果指标：联邦医疗保险按服务收费人群中的青光眼护理成本。结果：2009年，这一子集的联邦医疗保险支付的青光眼总费用为3740万美元，总估计成本为7.48亿美元，占所有联邦医疗保险FFS支付估计成本1920亿美元的0.4%。办公室就诊约占青光眼相关费用的一半，诊断性检查约占三分之一，手术和激光手术约占青光眼相关费用的10%。编码开角型青光眼(OAG)和疑似OAG占青光眼费用的87.5%，而人均费用最高的是“其他青光眼”。2009年，3%的开角型青光眼患者接受了切开手术，约5%的患者接受了激光小梁成形术。激光虹膜切开术是闭角型青光眼患者中费用最高的类别，而在其他青光眼组中，办公室就诊是费用最高的类别。青光眼患者的非青光眼眼部护理总费用比青光眼护理费用高出67%；这些费用主要用于白内障手术和视网膜疾病的治疗。从2002年到2009年，以2009年美元计算的FFS青光眼护理费用是稳定的，2009年人均每年费用从242美元下降到228美元(经线性趋势检验，P=0.01)。结论：2002年至2009年，人均每年青光眼护理费用按不变美元减少。青光眼患者的白内障和视网膜眼睛护理大大超过了他们每年的青光眼护理费用。探视费是最大的费用类别。
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.