Impact of vision loss on costs and outcomes in medicare beneficiaries with glaucoma

Objective: To assess the impact of vision loss severity on costs and health outcomes among Medicare beneficiaries with glaucoma. Methods: A retrospective cohort analysis was conducted using Medicare claims. Patients were stratified into 4 categories: no vision loss, moderate vision loss, severe vision loss, and blindness. Outcomes of interest were mean annual medical costs by category, component costs, and frequency of depression, falls and/or accidents, injury, femur fracture, and nursing home placement. Results: Multivariate regression analysis showed that patients with any degree of vision loss had 46.7% higher total costs compared with patients without vision loss. Mean total and component costs increased with onset and severity ($8157 for no vision loss to $18 670 for blindness). Patients with vision loss were significantly more likely to be placed in a nursing home (odds ratio=2.18; 95% confidence interval, 2.06-2.31), develop depression (odds ratio=1.63; 95% confidence interval, 1.54-1.73), fracture a femur (odds ratio=1.67; 95% confidence interval, 1.53-2.83), or experience a fall or accident (odds ratio=1.59; 95% confidence interval, 1.50-1.68) vs patients without vision loss. Conclusions: Vision loss in glaucoma is costly, and costs increase with severity. There is significantly increased risk of nursing home admission, depression, falls and/or accidents, injury, or femur fracture with vision loss compared with no vision loss.