Changes in Australian practice patterns for glaucoma management

• Published in: Clinical & experimental ophthalmology Vol. 47; no. 5; pp. 571 - 580
• Main Authors: Newman, Alexander R., Andrew, Nicholas H.
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.07.2019; Wiley Subscription Services, Inc
• Subjects: Aging; Drainage; Drainage facilities; Expenditures; Filtration; Glaucoma; glaucoma incisional surgery; glaucoma medical therapy; Government programs; Implantation; Lasers; Medicare; Ophthalmology; Population; Population growth; Schedules; glaucoma medical therapy; glaucoma; glaucoma incisional surgery
• ISSN: 1442-6404; 1442-9071
• DOI: 10.1111/ceo.13456

Importance The demand for glaucoma care is projected to increase significantly with the ageing population. Background To characterize trends in Australian practice patterns for glaucoma management over the 15‐y period between 2003 and 2017. Design Retrospective audit. Samples The Medicare eligible population. Methods Audit of Medicare Benefits Schedule item number reimbursements in the private healthcare sector, and dispensed Pharmaceutical Benefits Scheme (PBS) prescriptions. Main Outcome Measures Number, unadjusted cost and services per capita in the enrolled population. Results The number of medication prescriptions peaked in 2015, but then declined by 14.9%. PBS expenditure on glaucoma medications has been falling since 2012. There was a 9.2‐fold increase in fixed‐combination prescriptions and 281‐fold increase in unpreserved medication prescriptions. In 2017, optometrists generated 1.86% of glaucoma prescriptions. Reimbursements for computerized perimetry increased dramatically for optometrists, and in 2017 optometrist‐initiated perimetry exceeded ophthalmologist‐initiated perimetry by 35.3%. There were significant increases in laser procedure rates, including laser trabeculoplasty (4.61‐fold), laser iridotomy (2.55‐fold) and cyclodestructive procedures (2.33‐fold). There was a 3.83‐fold increase in glaucoma drainage device insertions. Ab interno trabecular microbypass procedures increased 715% from 2014 to 2017. Adjusted for Medicare population, trabecular microbypass is performed at more than twice the rate of primary filtering operations. Conclusions and Relevance This is the first time that glaucoma medication use and expenditure have declined since auditing began in 1992. Glaucoma laser procedures, drainage device implantation and trabecular microbypass increased substantially over the study period. In contrast, the rate of primary filtering operations increased in proportion to population growth. The increase in overall cost of glaucoma care has primarily been driven by computerized perimetry; however, this has been partially offset by a decline in medication expenditure.