The cost burden of falls in people with glaucoma in National Health Service Hospital Trusts in the UK

Aims: Falls have devastating consequences in older people with a considerable cost burden. Glaucoma is a risk factor for falls, and patients with glaucoma who fall are at high risk of hospital admission. The aim was to quantify the cost burden of falls to NHS Trusts in people with glaucoma in the UK. Methods: Financial data were used to identify non-elective episodes and associated costs from 2012 to 2018, for all admissions where glaucoma was recorded as a secondary diagnosis and admissions for falls (all, with and without a glaucoma secondary diagnosis). A secondary diagnosis is only recorded by the admitting clinician if it is clinically relevant; therefore, a secondary diagnosis of glaucoma was used as a proxy for glaucoma as a contributory factor to falls. Limitations: Use of financial records means that data on other falls risk factors was unavailable and we cannot be certain that glaucoma was the only relevant factor in all falls. Although this methodology is imperfect, case capture was biased towards cases with clinically significant glaucoma, and financial data is robust. Potential coding errors mean that we may have excluded patients in whom glaucoma was a factor in their fall. Results: At Maidstone and Tunbridge Wells (MTW) NHS Trust, 11.7% (95% confidence intervals [CI] = 10.7-12.8) of admissions for falls were in patients with a secondary diagnosis of glaucoma. This extrapolates to an estimated annual 10,056 admissions at a cost of 28.6 pound million across the UK. This is an under-estimate of cost, as A&E attendance without admission and outpatient appointments are excluded. Conclusions: At MTW, glaucoma potentially plays a part in around one in eight falls resulting in hospital admission, at considerable personal and financial cost. It is suggested that further work should explore early diagnosis of glaucoma, treatment, and mitigation of falls risk.