Comparing Costs of Monitoring Glaucoma Patients: Hospital Ophthalmologists versus Community Optometrists

Abstract

Objectives: To compare the costs of monitoring stable glaucoma patients by community optometrists and hospital ophthalmologists. Methods: A cost analysis was conducted alongside a randomised controlled trial which compared the accuracy and acceptability of measurement in each form of care. The viewpoints of the health service and of patients were considered. Costs were assessed using a number of different methods. Sensitivity analysis was conducted for key variables. Results: The baseline analysis reflected heavily the different length of time between follow-up in the two arms of the trial (10 months (average) for hospital, 6 months for optometrists). It showed annual cost per patient for hospital ophthalmologists varied from £14.50 to £59.95, and community optometrist costs varied from £68.98 to £108.98. Assuming a 6-month follow-up interval for the hospital ophthalmologists, costs varied from £24.16 to £99.92. Conclusions: Recommendations about the least costly form of follow-up must depend on the context in which the decision is being taken and the scale of change envisaged. If the aim is to recoup resources from hospitals in order to pay for monitoring in the community, community monitoring is unlikely to be the least costly option.