Latanoprost versus timolol as first choice therapy in patients with ocular hypertension. A cost-effectiveness analysis.
OBJECTIVE
To determine the cost-effectiveness of ocular hypertension (OH) treatment initiated with latanoprost compared to timolol.


METHODS
Two strategies for OH therapy are modelled, (1) 'starting with timolol' and (2) 'starting with latanoprost'. Therapy can be maintained or changed dependent on the achieved intraocular pressure (IOP) and side-effects. Adjustments of therapy to reach a target pressure involve monotherapy, combination therapy and laser. Four drugs are used: latanoprost, timolol, brimonidine and dorzolamide. Once the adjustments of therapy are completed, lifelong follow-up with IOP-dependent conversion to glaucoma and progression to blindness are modelled. Direct medical costs are assigned. The IOP-lowering effect of drugs is based on meta-analyses and applied by Monte Carlo simulation to a hypothetical cohort of patients with OH. The characteristics of the cohort, including the initial IOP distribution, are based on data of 1000 patients.


RESULTS
The IOP decreased from 25,4 mm Hg (mean) to 16.7 (±0.017) mm Hg (strategy 1) and to 16.5 (±0.013) mm Hg (strategy 2). Costs per patient within 15 months of therapy were € 367 and € 469, respectively. Lifetime blindness and costs were 0.0334 years and € 3,514 (strategy 1) and 0.0318 years and € 4,397 (strategy 2). Incremental costs per year of vision saved for strategy (2) in comparison with strategy (1) amount to, given the uncertainties in the model, approximately € 537,000.


CONCLUSIONS
For saving 1 year of vision, high costs are needed when OH therapy is initiated with latanoprost compared to timolol, when the cost price of latanoprost remains high.
Peeters
Andrea
A
Department of Ophthalmology, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands.
Schouten
Jan S A G
JS
Severens
Johan L
JL
Hendrikse
Fred
F
Prins
Martin H
MH
Webers
Carroll A B
CA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D000959:Antihypertensive Agents / Q000191:economics*; D001766:Blindness / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D016527:Drug Costs; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D000077338:Latanoprost; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D008962:Models, Theoretical; D009798:Ocular Hypertension / Q000188:drug therapy / Q000191:economics*; D011461:Prostaglandins F, Synthetic / Q000191:economics*; D013999:Timolol / Q000191:economics*; D014065:Tonometry, Ocular
D000959:Antihypertensive Agents; D011461:Prostaglandins F, Synthetic; D000077338:Latanoprost; D013999:Timolol