Socioeconomics Influencing Use of CXL Technology

Reviewed by Angela Gupta, MD

Geography and insurance plan type may limit patient accessibility to Cross Links (CXL).

CXL has been shown to be effective in treating patients with corneal ectasia. Although certain socioeconomic factors, such as insurance, gender and race, can predict the severity and rate of keratoconus keratoplasty, according to Angela Gupta, MD, PhD, and colleagues, socioeconomic factors associated with patients undergoing CXL have not been previously identified.

Gupta is a resident physician at the Scheie Eye Institute at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. She presented on CXL at the American Academy of Ophthalmology’s 2022 Annual Meeting in Chicago.

Gupta explained that she and her colleagues conducted a retrospective study to identify patients in the national insurance claims database from 2015 to 2020 to determine why they did not receive the technology and the possible role socioeconomic factors played .

Database Survey Results

The researchers found that a total of 108,504 patients were diagnosed with keratoconus, keratomacia, corneal deformity, or corneal ectasia during the study period. Of these, 552 patients with keratoconus or ectasia who received CXL were matched with 2723 controls who did not receive CXL.

The results showed that the acceptance of CXL increased over time. Gupta explained that while the number of patients opting for CXL was in the single digits in 2016, by 2019 that number had increased to more than 250 in this study.

Patient age appears to be a factor. Patients older than 30 years were significantly associated with (P = .003) reduces the likelihood of receiving CXL; patients 30 and younger accounted for more than 75% of patients who opted for CXL. The researchers suggest that the non-receipt of CXL in older patients may be due to treatment in the early stages of keratoconus or corneal ectasia. Gender, race, education, and patient income were not associated with the odds of receiving or not receiving CXL.

Gupta noted that patients who were members of health maintenance groups were also less likely to receive CXL (P=.047). In addition, patients residing in the East Coast and southern Midwest had lower rates of CXL (P = .001 for both).

“This is the first study to identify the socioeconomic characteristics of CXL, and [it] emphasize [that] Geography and insurance plans may limit patient access,” concluded Gupta. “We hope that identifying barriers to CXL can be a first step in ensuring equitable access to eye care for all patients. “

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