A Worldwide Price Comparison of Glaucoma Medications, Laser Trabeculoplasty, and Trabeculectomy Surgery | Glaucoma | JAMA Ophthalmology | JAMA Network
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Original Investigation
November 2018

A Worldwide Price Comparison of Glaucoma Medications, Laser Trabeculoplasty, and Trabeculectomy Surgery

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor
  • 2International Eye Foundation, Kensington, Maryland
  • 3National Clinician Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
  • 4Center for Eye Policy and Innovation, University of Michigan, Ann Arbor
  • 5King Saud University, Riyadh, Saudi Arabia
  • 6King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
  • 7Department of Ophthalmology, University of Illinois Eye and Ear Infirmary, Chicago
  • 8Department of Ophthalmology and School of International Health, Johns Hopkins University, Baltimore, Maryland
  • 9Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
JAMA Ophthalmol. 2018;136(11):1271-1279. doi:10.1001/jamaophthalmol.2018.3672
Key Points

Question  How affordable are common interventions for glaucoma (medications, laser trabeculoplasty, and trabeculectomy) for patients living in developing and developed countries throughout the world?

Findings  The annual cost of latanoprost, laser trabeculoplasty, and trabeculectomy were 2.5% or more of the median annual household income in 41%, 44%, and 78% of countries studied, respectively. Substantial variability in pricing was noted across countries for the glaucoma interventions studied.

Meaning  Successfully reducing global blindness from glaucoma requires addressing multiple contributing factors, including making glaucoma interventions more affordable.


Importance  Medical and surgical interventions for glaucoma are effective only if they are affordable to patients. Little is known about how affordable glaucoma interventions are in developing and developed countries.

Objective  To compare the prices of topical glaucoma medications, laser trabeculoplasty, and trabeculectomy relative with median annual household income (MA-HHI) for countries worldwide.

Design, Setting and Participants  Cross-sectional observational study. For each country, we obtained prices for glaucoma medications, laser trabeculoplasty, and trabeculectomy using government pricing data, drug databases, physician fee schedules, academic publications, and communications with local ophthalmologists. Prices were adjusted for purchasing power parity and inflation to 2016 US dollars, and annual therapy prices were examined relative to the MA-HHI. Interventions costing less than 2.5% of the MA-HHI were considered affordable.

Main Outcomes and Measures  Daily cost for topical glaucoma medications, cost of annual therapy with glaucoma medications, laser trabeculoplasty, and trabeculectomy relative to MA-HHI in each country.

Results  Data were obtained from 38 countries, including 17 developed countries and 21 developing countries, as classified by the World Economic Outlook. We observed considerable variability in intervention prices compared with MA-HHI across the countries and across interventions, ranging from 0.1% to 5% of MA-HHI for timolol, 0.1% to 27% for latanoprost, 0.2% to 17% for laser trabeculoplasty, and 0.3% to 42% for trabeculectomy. Timolol was the most affordable medication in all countries studied and was 2.5% or more of MA-HHI in only 2 countries (5%). The annual cost of latanoprost was 2.5% or more of MA-HHI in 15 countries (41%) (15 developing countries [75%] and no developed countries). The cost of laser trabeculoplasty was 2.5% or more of the MA-HHI in 15 countries (44%) (11 developing countries [65%] and 4 developed countries [24%]). The cost of trabeculectomy was 2.5% or more of the MA-HHI in 28 countries (78%) (18 developing countries [95%] and 10 developed countries [59%]). In 18 countries (53%), laser trabeculoplasty cost less than a 3-year latanoprost supply.

Conclusions and Relevance  For many patients worldwide, the costs of medical, laser, and incisional surgical interventions were 2.5% or more of the MA-HHI. Successfully reducing global blindness from glaucoma requires addressing multiple contributing factors, including making glaucoma interventions more affordable.