Cost-effectiveness of monotherapy treatment of glaucoma and ocular hypertension with the lipid class of medications.
OBJECTIVE
Cost-effectiveness evaluation of monotherapy with the newer lipid class of intraocular pressure (IOP)-lowering medications in glaucoma and ocular hypertension.


METHODS
Retrospective pharmacoeconomic analysis.


METHODS
Analysis included all published studies measuring IOP reduction from untreated baseline with once-daily bimatoprost (Lumigan), latanoprost (Xalatan), or travoprost (Travatan) monotherapy in patients with elevated IOP. Percentage IOP reduction at the final study visit was calculated using the early morning IOP measurement to control for diurnal variation in IOP. Patient-weighted average percentage IOP reductions were computed for each medication. Cost per 2.5-ml bottle was determined using PriceAlert 2005 (February). Cost-effectiveness was defined as monthly cost of medication per patient-weighted average 1% reduction in IOP.


RESULTS
Studies included 951 bimatoprost, 1598 latanoprost, and 765 travoprost patients. The AWP in February, 2005 for a 2.5-ml bottle was 62.10 dollars for bimatoprost, 61.29 dollars for latanoprost, and 62.19 dollars for travoprost. Patient-weighted average IOP reduction was 32.4% for bimatoprost, 29.6% for latanoprost, and 29.0% for travoprost. Calculated cost-effectiveness was 1.92 dollars for bimatoprost, 2.07 dollars for latanoprost, and 2.14 dollars for travoprost. Incremental cost-effectiveness ratio (ICER) analysis showed an incremental cost of 0.29 dollars for each additional 1% IOP reduction provided by bimatoprost over latanoprost. The rank order of the cost-effectiveness of the drugs (bimatoprost > latanoprost > travoprost) was robust in sensitivity analyses to cost and efficacy.


CONCLUSIONS
On the basis of AWP and patient-weighted average percentage IOP reduction in published studies, bimatoprost had the most favorable cost-effectiveness among the drugs compared. Cost-effectiveness should be considered along with traditional clinical safety and efficacy measures to make individual and group healthcare decisions.
Noecker
Robert J
RJ
Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. noeckerrj@upmc.edu
Walt
John G
JG
D000577:Amides; D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use; D000069580:Bimatoprost; D003008:Cloprostenol / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005901:Glaucoma / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D000077338:Latanoprost; D008055:Lipids / Q000191:economics* / Q000627:therapeutic use; D009798:Ocular Hypertension / Q000188:drug therapy / Q000191:economics; D011461:Prostaglandins F, Synthetic / Q000191:economics* / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D000069557:Travoprost
D000577:Amides; D000959:Antihypertensive Agents; D008055:Lipids; D011461:Prostaglandins F, Synthetic; D003008:Cloprostenol; D000077338:Latanoprost; D000069580:Bimatoprost; D000069557:Travoprost