Naturalistic, prospective study of glaucoma and ocular hypertension treatment in France: strategies, clinical outcomes, and costs at 1 year.
OBJECTIVE
To prospectively observe second-line treatment strategies, their clinical outcomes, and treatment costs in patients with glaucoma or ocular hypertension (OH) in France.


METHODS
Patients were recruited between 1998 and 2000 in 37 centers and were followed for up to 2 years. Outcomes were numbers of and reasons for treatment changes, changes in clinical parameters (intraocular pressure [IOP] levels, visual field defects, and optic nerve excavation), and direct medical costs associated with glaucoma management in patients receiving monotherapy or combination therapy. This article reports results of an interim analysis of 1-year follow-up data for patients having at least two contacts with a study ophthalmologist.


RESULTS
Data were analyzed for 283 patients and 549 treated eyes. Ocular hypotensive monotherapy was used as first-line therapy in 92.0% of eyes. Second-line treatment was initiated an average of 3.4 +/- 0.5 years after diagnosis, primarily due to insufficient IOP control (62.8%). Mean IOP reductions after 1 year of second-line therapy were 3.0 mmHg in eyes treated with latanoprost monotherapy versus 2. 1 mmHg in those receiving beta-blocker monotherapy (p = 0.02) and 5.4 mmHg in eyes treated with the latanoprost + timolol combination versus 4.1 mmHg in those receiving combination therapies that did not include latanoprost (p = 0.01). Although second-line treatment with latanoprost was more costly than treatment with beta blockers, the average daily cost for latanoprost monotherapy was similar to that for patients who failed beta-blocker monotherapy, and latanoprost + timolol was less costly than therapeutic combinations without latanoprost.


CONCLUSIONS
Insufficient IOP control is the main reason for changing first-line treatment in patients with glaucoma or OH. After 1 year, second-line treatment with latanoprost, as monotherapy or combined with timolol, provides superior IOP control at an acceptable cost.
Rouland
J F
JF
Ophthalmology Service, Regional and University Hospital Center, Claude Huriez Hospital, Lille, France. jfr3@wanadoo.fr
Le Pen
C
C
D000368:Aged; D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D016527:Drug Costs; D004359:Drug Therapy, Combination; D005260:Female; D005602:France; D005902:Glaucoma, Open-Angle / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D009798:Ocular Hypertension / Q000191:economics / Q000628:therapy; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D016896:Treatment Outcome
D000959:Antihypertensive Agents