A cost-effectiveness analysis of fixed-combination therapies in patients with open-angle glaucoma: a European perspective.
OBJECTIVE
To compare the efficacy and cost implications of the use of the intraocular pressure-lowering prostaglandin analogues bimatoprost, travoprost, and latanoprost as fixed-combination therapies with timolol, a beta-adrenergic receptor antagonist.


METHODS
A decision analytic cost-effectiveness model was constructed. Since no head-to-head studies comparing the three treatment options exist, the analysis was based on an indirect comparison. Hence, the model was based on efficacy data from five randomized, controlled, clinical studies. The studies were comparable with respect to study design, time horizon, patient population and type of end point presented. The measure of effectiveness was the percentage reduction of the intraocular pressure level from baseline. The cost evaluated was the cost of medication and clinical visits to the ophthalmologist. All drug costs were market prices inclusive of value-added tax, and visit costs were priced using official physician fees. Cost-effectiveness analyses were carried out in five European countries: Spain, Italy, United Kingdom, Norway and Sweden. The time horizon for the analyses was 3 months.


RESULTS
The analysis showed that fixed-combination bimatoprost/timolol was more effective and less costly than fixed-combination travoprost/timolol and fixed-combination latanoprost/timolol in three out of the five countries analyzed. In two countries, bimatoprost/timolol was less costly than latanoprost/timolol, and cost the same as travoprost/timolol.


CONCLUSIONS
This cost-effectiveness analysis showed that the fixed combination of bimatoprost 0.03%/timolol 0.5% administered once daily was a cost-effective treatment option for patients with primary open-angle glaucoma. This study was limited by available clinical data: without a head-to-head trial, indirect comparisons were necessary. In the United Kingdom, Sweden, Norway, Italy, and Spain, from a health service viewpoint, bimatoprost/timolol was a slightly more effective as well as less costly treatment strategy when compared to both travoprost/timolol and latanoprost/timolol.
Hommer
A
A
Krankenanstalt Sanatorium, Vienna, Austria.
Wickstrøm
J
J
Friis
M M
MM
Steeds
C
C
Thygesen
J
J
Ferreras
A
A
Gouws
P
P
Buchholz
P
P
D000319:Adrenergic beta-Antagonists / Q000191:economics / Q000627:therapeutic use; D000577:Amides / Q000191:economics / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use*; D000069580:Bimatoprost; D003008:Cloprostenol / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004359:Drug Therapy, Combination; D005060:Europe; D005902:Glaucoma, Open-Angle / Q000188:drug therapy* / Q000191:economics* / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D000077338:Latanoprost; D018803:Models, Economic; D011461:Prostaglandins F, Synthetic / Q000191:economics / Q000627:therapeutic use; D011465:Prostaglandins, Synthetic / Q000627:therapeutic use; D013999:Timolol / Q000191:economics / Q000627:therapeutic use; D000069557:Travoprost
D000319:Adrenergic beta-Antagonists; D000577:Amides; D000959:Antihypertensive Agents; D011461:Prostaglandins F, Synthetic; D011465:Prostaglandins, Synthetic; D003008:Cloprostenol; D000077338:Latanoprost; D013999:Timolol; D000069580:Bimatoprost; D000069557:Travoprost