Treatment of glaucoma in clinical practice: four-year results from a patient registry in France.
OBJECTIVE
To investigate long-term resource consumption and clinical outcome of patients with early primary open-angle glaucoma or ocular hypertension treated with prostaglandins in clinical practice in France.


METHODS
Thirty-four geographically spread specialized hospitals and private practices enrolled consecutive patients receiving, for the first time, a prostaglandin, alone or in combination. The study was based on routine practice and no consultations, examinations, or treatments were mandated by the protocol. Treating physicians recorded each consultation, including all examinations performed, referrals, admissions, and prescriptions. Descriptive analysis of resource consumption and development of intraocular pressure (IOP) and visual fields was performed, for all patients who completed the 4-year follow-up.


RESULTS
The study enrolled 602 patients and 78% completed 4-year follow-up. Mean age was 65 years and mean time since diagnosis was 4 years. Mean IOP was reduced from a baseline of 21.2 mm Hg to 16.5 mm Hg during the first year and remained stable throughout the study. Mean visual fields at baseline were -4.2 mean deviation and stable during the follow-up. Total mean health care costs per patient were €1947, of which medication represented 50%. Over half of the patients (52%) remained on their initial medication during the 4 years. Drug changes were mostly because of inadequate IOP control and the number of treatment switches was significantly related to costs.


CONCLUSIONS
This is the first prospective study of treatment with prostaglandins in clinical practice. The results indicate that many patients with early glaucoma managed primarily with prostaglandins will show very little progression over 4 years. Compared with the mid-90s, costs have not increased despite the higher acquisition cost of prostaglandins, as surgical interventions and medical consultations have decreased.
Kobelt
Gisela
G
European Health Economics, Speracedes, France. Gisela.kobelt@he-europe.com
Texier-Richard
Brigitte
B
Buchholz
Patricia
P
Bron
Alain
A
Renard
Jean-Paul
JP
Rouland
Jean-Francois
JF
Nordmann
Jean-Philippe
JP
D000368:Aged; D000369:Aged, 80 and over; 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; D016527:Drug Costs; D005260:Female; D005602:France; D005902:Glaucoma, Open-Angle / Q000188:drug therapy / Q000191:economics* / Q000503:physiopathology; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D000077338:Latanoprost; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000188:drug therapy / Q000191:economics / Q000503:physiopathology; D011446:Prospective Studies; D011461:Prostaglandins F, Synthetic / Q000191:economics / Q000627:therapeutic use; D012042:Registries; D000069557:Travoprost
D000577:Amides; D000959:Antihypertensive Agents; D011461:Prostaglandins F, Synthetic; D003008:Cloprostenol; D000077338:Latanoprost; D000069580:Bimatoprost; D000069557:Travoprost