Forecasting trends in glaucoma medication reimbursees in Finland: Updated system dynamics model to 2070

Background/aims Glaucoma is among the leading causes of permanent visual impairment, with its prevalence increasing due to population ageing. This study aimed to evaluate the accuracy of the 2004 system dynamics (SD) model predicting the number of glaucoma medication reimbursees in Finland until 2023, update the model using 1990-2023 data to forecast medication users until 2070 and assess whether the observed deceleration in net growth during 2015-2023 represented a temporary or sustained trend. Methods Data on reimbursed glaucoma medication users (1986-2023) were sourced from the Finnish Social Insurance Institution, alongside Finnish population projections (2021-2070). An updated SD model was developed using historical data, stratified by age groups, and incorporating demographic shifts, mortality and migration. Predictions were validated against observed trends and parameterised using expert consensus and literature estimates. Results By 2070 in Finland, the updated model predicts a 57% increase in glaucoma medication reimbursees (151 846 individuals; 28 per 1000 inhabitants), primarily driven by growth in ≥75-year-old population. The updated model captured the slowdown in net growth of reimbursees in 2015-2023. A similar slowdown is projected to reoccur during 2033-2048, again followed by an acceleration in growth. Conclusions The demand for glaucoma care in Finland will increase by 2070, necessitating proactive resource allocation and continuous monitoring using real-world data to ensure optimal care delivery. Temporary changes in the demand for glaucoma care underscore the need for adaptive forecasting methods. The updated model provides a framework for monitoring trends and informing resource allocation in national eye care systems.