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Abstract #46871 Published in IGR 13-3
Cost-effectiveness analysis of formulary management strategies for first-line agents used in open-angle glaucoma and ocular hypertension
Blaser DA; Ousterhout MM; Gagnon JM; Calabrese DValue in Health 2011; 14: A55
OBJECTIVES: To determine which formulary management strategy of ophthalmic prostaglandins (PGs) is the most cost-effective from the perspective of a managed care organization (MCO) over one year. METHODS: This cost-effectiveness model contains eight unique arms, which reflect different formulary management strategies for the PGs (bimatoprost, latanoprost, travoprost). Three arms examine the cost-effectiveness of each PG as first-line therapy, with timolol added as secondline therapy for patients not reaching goal intraocular pressure (IOP). The next three arms examine first-line therapy with timolol, an alternative and less costly primary therapy, with a preferred PG as second-line therapy. An additional arm examines not selecting a preferred PG as first-line therapy with timolol as secondline therapy, and the final arm examines timolol as first-line therapy, but does not select a preferred PG as second-line. An effectively treated patient was defined as a patient achieving an IOP less than 18 mm Hg after three months of therapy. If patients were unable to reach goal IOP with secondary-line therapy, dorzolamide was added. Patients unable to tolerate therapy or achieve goal IOP required additional physician visits. Costs included prescription medications and physician visits in 2010 US dollars. RESULTS: The cost-effectiveness ratios (CER) for first-line therapy with a preferred PG were $815.13, $961.71, and $889.13 per effectively treated patient for bimatoprost, latanoprost, and travoprost, respectively. The CERs for first-line therapy with timolol, followed by a preferred PG, were $436.77, $499.77, and $462.21 for bimatoprost, latanoprost, and travoprost, respectively. If a preferred PG was not selected, the CERs were $910.95 for first-line therapy and $477.77 for second-line therapy. Sensitivity analyses showed that reducing the price of latanoprost by 9 percent and travoprost by 3 percent yields equivalent CERs as bimatoprost. CONCLUSIONS: Timolol followed by a bimatoprost is the most cost-effective of the eight treatment strategies examined in this model.
D.A. Blaser. UMass Medical School, Shrewsbury, United States.
Classification:
14 Costing studies; pharmacoeconomics
