OBJECTIVES: Glaucoma is the second leading cause of irreversible blindness in the US and is often asymptomatic and underdiagnosed. Recent studies have explored interventions to improve early glaucoma detection, but data regarding their economic burden remains limited. We present direct medical costs experienced by those in a patient navigator intervention as compared to usual care in the Philadelphia Telemedicine Glaucoma Detection and Follow-Up Eye Care Study (PTGD), a two-part primary care-based intervention designed to detect glaucoma via telemedicine screening and use a patient navigator to improve adherence to recommended follow-up glaucoma eye care visits.

METHODS: In Part 1 of the study, a telemedicine eye examination was performed to screen for glaucoma. If glaucoma was detected, participants received a confirmatory ophthalmologist examination. In Part 2, those with confirmed glaucoma were randomized to usual care (UC) or enhanced intervention (EI). In EI, a patient navigator assessed barriers to recommended follow-up visit adherence, helped schedule visits, and provided reminder telephone calls. Direct costs (examinations, procedures, and medications) were estimated from practice billing codes and prevailing Medicare reimbursement rates. Number of follow-up visits and per-participant direct costs during Part 2 were compared between groups via Wilcoxon rank-sum tests.

RESULTS: Participants in EI had significantly greater adherence to recommended follow-up visits than those in UC (mean 2.2 vs. 1.0 visits/participant, p<0.0001). Examination costs were higher in EI vs. UC ($152.90/participant vs. $82.60/participant respectively, p<0.0001). Similarly, procedure costs were higher in EI vs. UC ($43.80/participant vs. $23.50/participant respectively, p<0.0001). Costs of newly prescribed eye medications were lower in EI vs. UC ($21.75/participant vs. $28.84/participant respectively, p=0.0003), whereas costs of current eye medications were higher in EI vs. UC ($59.93/participant vs. $48.35/participant, p=0.0103).

CONCLUSIONS: Primary care-based screenings represent a novel means of early glaucoma detection. Though EI experienced greater per-participant direct costs, this group showed improved adherence to follow-up care.