Economic burden of glaucoma in Rivers State, Nigeria

Abstract

BackgroundPrimary open angle glaucoma is reported to blind 150,000 people in the Nigerian population and over 7000 in Rivers State, and requires constant follow-up. Compliance is a challenge, given that most inhabitants live below the poverty line. This study was performed to determine how Nigerian patients are affected economically by the disease.MethodsConsecutive adult patients attending the eye clinic of the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria, with a diagnosis of primary open angle glaucoma and on outpatient antiglaucoma treatment in the first 6 months of 2006, were recruited for the study. The lowest paid government worker was on USD50 (N7500.00) per month and the gross domestic product per capita was USD1150 for the period under review.ResultsWe enrolled 120 consecutive patients of mean age 52.7 ± 10.4 years, with a male to female ratio of 2:3. The most common occupations were in the civil service (n = 56, 46.7%). All participants were on topical antiglaucoma treatment. The average cost of medical antiglaucoma medication was N6000 (USD40) per month. Computed to include indirect costs, including medical laboratory tests, transportation, and care by patient escorts, an average sum of USD105.4 (N15,810) was spent by each patient per month. Most of the patients (73.3%) were responsible for their own treatment costs. No patient accepted the cheaper option of surgery (USD275.4, N41,310). Eighty of the patients (66.7%) visited our eye clinic monthly. Direct and indirect loss to the economy was USD3,064587 per annum from those already blind. This was in addition to the USD 4.1 million being spent yearly on medical treatment by those who were visually impaired by glaucoma.ConclusionMiddle-income earners spent over 50% of their monthly income and low-income earners spend all their monthly earnings on treatment for glaucoma. This situation often resulted in noncompliance with treatment and hospital follow-up visits. To reduce the economic burden of glaucoma, trabeculectomy performed by experienced surgeons should be offered as first-line treatment for glaucoma in this country, rather than medical therapy.

Cost of glaucoma treatment in a developing country over a 5-year period

“…[8] Glaucoma is a stressful disease on family finances, the greater part of treatment expenditure is on medication at present, with more potent but more costly topical hypotensive replacing the old treatments. [20] Studies have shown that in developing countries, direct costs referring to hospital visits, glaucoma-related procedures, and hypotensive medications are significant; and indirect costs indicating transportation, hours away from work, and nursing homes are also considerable. [14,20] It has been published that both—the growing global and individual costs of glaucoma—increase as the disease worsens.…”

“…[20] Studies have shown that in developing countries, direct costs referring to hospital visits, glaucoma-related procedures, and hypotensive medications are significant; and indirect costs indicating transportation, hours away from work, and nursing homes are also considerable. [14,20] It has been published that both—the growing global and individual costs of glaucoma—increase as the disease worsens. [8,14,20] Early identification and treatment of POAG may reduce personal and societal economic burdens.…”

“…[14,20] It has been published that both—the growing global and individual costs of glaucoma—increase as the disease worsens. [8,14,20] Early identification and treatment of POAG may reduce personal and societal economic burdens. [14] …”

“…Adio and Onua [20] performed an analysis of the direct and indirect costs to determine the economic challenge of POAG in Rivers State, Nigeria; they reported that the average glaucoma patient has an expense of 49.8% of their monthly income. In our study, we found that more than half of the patients belong to the low-income group and they showed an average direct-cost expense of 61.5% of their monthly income.…”

“…[15] It has been described that the raise in severity of the disease increases the financial burden. [14,20] Quality of life, a wide-ranging well-being concept of the individual's perception of his/her position of various features of his/her life, has an inverse association with glaucoma, its resultant visual impairment, and economic burden of its treatment. [21–23] It is important to know how much each patient spends on the treatment of their disease and accurately measure the impact on their monthly income in our country.…”