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Abstract #8794 Published in IGR 5-1
Cost-minimisation study of dorzolamide versus brinzolamide in the treatment of ocular hypertension and primary open-angle glaucoma: In four european countries
Rouland JF; Le Pen C; Pinto CG; Berto P; Berdeaux GPharmacoEconomics 2003; 21: 201-213
OBJECTIVE: Cost is an issue when prescribing two drugs with equivalent efficacy. The authors compared the direct medical costs of topical brinzolamide 1% (twice or three times daily) with topical dorzolamide 2% (twice or three times daily) in France, Italy, Portugal, and Spain in patients with ocular hypertension or primary open-angle glaucoma. DESIGN AND SETTING: Three double-blind, controlled, randomized trials (with a study duration of three months) compared the response rate of brinzolamide twice or three times daily versus dorzolamide three times daily, and the response rate of brinzolamide-timolol twice a day versus a dorzolamide-timolol combination twice a day. A fourth double-blind randomized trial (with a duration of 12 months) compared brinzolamide twice and three times daily with timolol monotherapy. Local tolerance was compared in two dedicated studies. Rates of switching to a new medication regimen were evaluated through a US health maintenance organisation database. In case of treatment failure, the patients were treated with latanoprost. A model was developed to value direct medical costs over three months. The economic perspective was that of the third-party payer and the patient, and included direct medical costs (reimbursed part plus co-payment). PATIENTS: Patients with ocular hypertension and/or primary open-angle glaucoma who had not responded to or could not tolerate β-blocker therapy. OUTCOME MEASURE: The daily direct medical costs of therapy with the two drugs. RESULTS: As monotherapy, brinzolamide twice or three times daily was found to be as efficacious as dorzolamide three times a day. Brinzolamide twice daily plus timolol was also as efficacious as a combination of dorzolamide and timolol twice a day. Stinging of the eye upon instillation with brinzolamide was experienced by fewer patients than with dorzolamide (p < 0.0001). The likelihood of patients treated with dorzolamide changing therapy was 1.28 times greater than that for those treated with brinzolamide. The size of the brinzolamide drop is 18.7% smaller than that of dorzolamide, allowing seven more therapy days per bottle with brinzolamide twice daily than with dorzolamide monotherapy, and five more days when brinzolamide is used three times a day. The direct medical costs for patients treated with brinzolamide were lower in all four European countries when drop size was taken into account than for those treated with dorzolamide. Sensitivity analyses confirmed the robustness of these findings. CONCLUSION: Because brinzolamide can be prescribed twice daily in monotherapy and because fewer patients treated with brinzolamide switch therapy due to local intolerance, this model suggests that brinzolamide is a cost-saving alternative to dorzolamide.
Dr. G. Berdeaux, Alcon France, 4, Rue Henri Sainte-Claire Deville, F-92563 Rueil-Malmaison Cedex, France. gilles.berdeaux@alconlabs.com
Classification:
11.5.2 Topical (Part of: 11 Medical treatment > 11.5 Carbonic anhydrase inhibitors)
