OBJECTIVES: To evaluate the healthcare resource use and costs of patients initiating incrementally higher numbers of topical glaucoma medications (TGMs) for management of open-angle glaucoma (OAG) or ocular hypertension (OHT).

METHODS: This was a retrospective analysis of administrative claims data (Jan 2011 ─ July 2017) from the IQVIA PharMetrics Plus database. The study included patients ≥40 years with a diagnosis of OAG/OHT who underwent treatment initiation or intensification with ≥1 TGM of a different drug class during Jan 2012 ─ July 2015 (index period). Over a 2-year period, we evaluated the total health care costs including eye-related physician care, glaucoma surgical costs, lab testing and pharmaceutical use.

RESULTS: In total, 48,402 patients (mean [SD] age 61.4 [9.6] years); underwent treatment intensification during the index period; of these, 22,874 (47.3%), 16,214 (33.5%), 7,137 (14.7%) and 2,177 (4.5%) received a one, two, three or four TGM classes, respectively, as their first observed intensified regimen (‘index drop combination’). Among the index cohorts receiving 1, 2, 3 or 4 TGMs utilization and intensity of glaucoma service use increased monotonically with each additional drop with average non-inpatient costs (physician, labs and surgery) of $1,368 (SD=$3,215), $2,040 (SD=$4,472), $2,354 (SD=$4,562) and $2,924 (SD=$5,607) respectively over two years. Two-year average per-patient pharmaceutical costs were $819 (SD=$1,021), $1,351 (SD=$1,409), $1,988 (SD=$1,713) and $3,042 (SD=$2,299), respectively. Notably, the proportion with surgical procedures was 8.1% in the 1^st drop initiator cohort compared to 33.0% in the 4^th drop initiations with an average per-user cost of $1,657 (SD=$2,007) compared to $3,063 (SD=$3,599) respectively.

CONCLUSIONS: Treatment costs and frequency of surgical procedures increased substantially for each incremental drop cohort. The economic burden of progression to additional TGMs may be alleviated by treatments with a more durable effect or earlier and consistent use of safe and effective procedures.