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1 General aspects (0)   1.1 Epidemiology (19)   1.2 Population genetics (0)   1.3 Pathogenesis (5)   1.4 Quality of life (12)   1.5 Glaucomas as cause of blindness (13)   1.6 Prevention and screening (10) 2 Anatomical structures in glaucoma (0)   2.1 Conjunctiva (4)   2.2 Cornea (20)   2.3 Sclera (10)   2.4 Anterior chamber angle (8)   2.5 Meshwork (0)     2.5.1 Trabecular meshwork (9)     2.5.2 Schlemms canal (1)     2.5.3 Scleral outlet channels (0)   2.6 Aqueous humor dynamics (0)     2.6.1 Production (1)     2.6.2 Outflow (0)       2.6.2.1 Trabecular meshwork (5)       2.6.2.2 Uveoscleral (1)     2.6.3 Compostion (1)   2.7 Episcleral veins and venous pressure (1)   2.8 Iris (2)   2.9 Ciliary body (1)   2.10 Lens (0)   2.11 Vitreous body (0)   2.12 Choroid, peripapillary choroid, peripapillary atrophy (3)   2.13 Retina and retinal nerve fibre layer (25)   2.14 Optic disc (22)   2.15 Optic nerve (2)   2.16 Chiasma and retrochiasmal central nervous system (2)   2.17 Stem cells (3)   2.20 Other (0) 3 Laboratory methods (0)   3.1 Microscopy (3)   3.2 Electron microscopy (1)   3.3 Immunohistochemistry (2)   3.4 Molecular genetics (0)     3.4.1 Linkage studies (1)     3.4.2 Gene studies (28)   3.5 Molecular biology incl. SiRNA (9)   3.6 Cellular biology (35)   3.7 Biochemistry (5)   3.8 Pharmacology (8)   3.9 Pathophysiology (9)   3.10 Immunobiology (2)   3.11 Pharmacogenetics (0)   3.12 Proteomics (1)   3.13 In vivo imaging (0)     3.13.1 Laser Scanning (0)       3.13.1.1 Confocal Scanning Laser Ophthalmoscopy (1)       3.13.1.2 Confocal Scanning Laser Polarimetry (0)     3.13.2 Optical Coherence Tomography (0)       3.13.2.1 Anterior Segment (1)       3.13.2.2 Posterior Segment (2)     3.13.3 RGC Imaging (1)     3.13.4 Other (0)   3.20 Other (0) 4 Tissue culture of ocular cells (0) 5 Experimental glaucoma; animal models (0)   5.1 Rodent (26)   5.2 Primates (6)   5.3 Other (14) 6 Clinical examination methods (0)   6.1 Intraocular pressure measurement; factors affecting IOP (0)     6.1.1 Devices, techniques (18)     6.1.2 Fluctuation, circadian rhythms (6)     6.1.3 Factors affecting IOP (8)   6.2 Tonography, aqueous flow measurement (see also 2.6) (0)   6.3 Biomicroscopy (slitlamp) (1)     6.3.1 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Refractive errors in relation to glaucoma (0)   8.1 Myopia (6)   8.2 Hypermetropia (0)   8.3 Contact lenses (0)   8.4 Refractive surgical procedures (0)   8.5 Other (0) 9 Clinical forms of glaucomas (0)   9.1 Developmental glaucomas (0)     9.1.1 Congenital glaucoma, Buphthalmos (6)     9.1.2 Juvenile glaucoma (9)     9.1.3 Syndromes of Axenfeld, Rieger, Peters, aniridia (8)     9.1.4 Other (1)   9.2 Primary open angle glaucomas (0)     9.2.1 Ocular hypertension (0)     9.2.2 Other risk factors for glaucoma (11)     9.2.3 Open angle glaucoma with elevated IOP (1)     9.2.4 Normal pressure glaucoma (13)   9.3 Primary angle closure glaucomas (0)     9.3.1 Acute primary angle closure glaucoma (pupillary block) (5)     9.3.2 Chronic primary angle closure glaucoma (pupillary block) (0)     9.3.3 Plateau iris syndrome (0)     9.3.4 Primary angle closure suspect (1)     9.3.5 Primary angle closure (5)     9.3.10 Other (0)   9.4 Glaucomas associated with other ocular and systemic disorders (0)     9.4.1 Steroid-induced glaucoma (6)     9.4.2 Glaucomas associated with disorders of the cornea, conjunctiva, sclera (1)       9.4.2.1 Iridocorneal endothelial syndrome (ICE, incl. irisatrophy) (2)       9.4.2.2 Posterior polymorphous dystrophy (0)       9.4.2.3 Fuchs' endothelial dystrophy (0)       9.4.2.5 Other (1)     9.4.3 Glaucomas associated with disorders of the iris and ciliary body (0)       9.4.3.1 Pigmentary glaucoma (0)       9.4.3.5 Other (0)     9.4.4 Glaucomas associated with disorders of the lens (0)       9.4.4.1 Exfoliation syndrome (10)       9.4.4.2 Glaucomas associated with cataracts (2)       9.4.4.3 Glaucomas associated with lens dislocation (0)       9.4.4.5 Other (1)     9.4.5 Glaucomas associated with disorders of the retina, choroid and vitreous (0)       9.4.5.1 Neovascular glaucoma (5)       9.4.5.5 Other (9)     9.4.6 Glaucomas associated with inflammation, uveitis (6)     9.4.7 Glaucomas associated with ocular trauma (5)     9.4.8 Glaucomas associated with intraocular tumors (0)     9.4.9 Glaucomas associated with elevated episcleral venous pressure (0)       9.4.10 Glaucomas associated with hemorrhage (4)     9.4.11 Glaucomas following intraocular surgery (0)       9.4.11.1 Ciliary block (malignant) glaucoma (0)       9.4.11.2 Glaucomas in aphakia and pseudophakia (10)       9.4.11.3 Epithelial, fibrous, and endothelial proliferation (0)       9.4.11.4 Glaucomas associated with corneal surgery (7)       9.4.11.5 Glaucomas associated with vitreoretinal surgery (4)     9.4.15 Glaucoma in relation to systemic disease (16)     9.4.20 Other (0) 10 Differential diagnosis e.g. anterior and posterior ischemic optic neuropathy (1) 11 Medical treatment (0)   11.1 General management, indication (5)   11.2 Cholinergic drugs (0)   11.3 Adrenergic drugs (0)     11.3.1 Epinephrine (0)     11.3.2 Thymoxamine, dapiprazole (0)     11.3.3 Apraclonidine, brimonidine (2)     11.3.4 Betablocker (5)     11.3.5 Other (0)   11.4 Prostaglandins (32)   11.5 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Without tube implant (8)     12.8.2 With tube implant or other drainage devices (16)     12.8.3 Non-perforating (3)     12.8.4 Using laser (0)     12.8.5 Other (1)     12.8.10 Woundhealing antifibrosis (16)     12.8.11 Complications, endophthalmitis (9)   12.9 Trabeculotomy, goniotomy (4)   12.10 Cyclodestruction (1)   12.11 Cyclodialysis (1)   12.12 Cataract extraction (0)     12.12.1 Intracapsular (0)     12.12.2 Extracapsular (0)     12.12.3 Phacoemulsification (4)   12.14 Combined cataract extraction and glaucoma surgery (0)     12.14.1 Intracapsular (0)     12.14.2 Extracapsular (0)     12.14.3 Phacoemulsification (3)   12.15 Capsulotomy (0)   12.16 Vitrectomy (0)   12.17 Anesthesia (4)   12.20 Other (1) 13 Therapeutic prognosis and outcome (0)   13.1 Prognostic factors (0)   13.2 Outcome (0)     13.2.1 IOP (1)     13.2.2 Visual field (0)       13.2.2.1 Progression (0)       13.2.2.2 Improvement (0)     13.2.3 Other (0) 14 Costing studies; pharmacoeconomics (14) 15 Miscellaneous (15)

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Abstract #47832 Published in IGR 13-4

Economic outcomes of glaucoma treatment with prostaglandin eye drops preserved with polyquad(registered trademark) instead of benzalkonium chloride in Germany

Gerlier L; Lamotte M; Lorenz K; Berdeaux G; Verboven Y; Pfeiffer N
Value in Health 2011; 14: A503

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OBJECTIVES: In glaucoma patients, the long term use of prostaglandin eye drops containing benzalkonium chloride (BAK) increases the risk of developing an ocular surface disease (OSD). Polyquad(registered trademark) preserved prostaglandins are now available, among which travoprost proved similar in efficacy and safety compared to BAKpreserved formulations. We aimed to estimate the impact of Polyquad(registered trademark) instead of BAK on glaucoma management cost. METHODS: A Markov microsimulation model was developed in TreeAge, including 5 health states corresponding to 4 treatment lines plus death, in representative, treatment-naive patients at different OHT/glaucoma stages. The sequence travoprost-travoprost+timolol fixed combination preserved with Polyquad(registered trademark) was compared to BAK-preserved latanoprostlatanoprost +timolol (LAT) and bimatoprost-bimatoprost+timolol (BIM). The model events were: onset of OSD (risk factors: age, sex, BAK exposure; sources: US incidence study [Moss 2005], Erb 2008), need for treatment change including surgery/ laser (risk factors: treatment line, disease stage, OSD presence, BAK exposure; sources: persistence studies in UK GPRD [Lafuma 2007] and US claims database [Schmier 2010]), and disease progression (risk factors: treatment line, OSD severity, non-compliance; sources: large prospective studies in OHT/glaucoma). Costs data came from a German observational study in OHT/glaucoma with 5-year retrospective collection of medical resources used (Statutory Health Insurance perspective+ patient co-payments; 2011 drug costs, other costs 2010). The 95% confidence intervals came from a probabilistic sensitivity analysis. RESULTS: After 10 years, the total management cost in the travoprost with Polyquad(registered trademark) arm was (euro)4677 [4378; 5013] compared to (euro)5196 [4904;5482] with LAT and (euro)5342 [5069;5664] with BIM. More patients required eye surgery/laser procedures with BAK-preserved sequences (LAT: 4.7% [3.2;6.4%], BIM: 6.0% [4.0;8.3%]) compared to travoprost with Polyquad(registered trademark) (1.8% [0.9;2.9%]). CONCLUSIONS: At 10 years, prostaglandin treatment with Polyquad (registered trademark) is expected to reduce the cost of glaucoma treatment by 10-15% from both individual and societal perspectives, and have lower surgery/laser rates compared to BAK-preserved treatments.

L. Gerlier. IMS Consulting Group, Vilvoorde, Belgium.

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Classification:

11.4 Prostaglandins (Part of: 11 Medical treatment)
11.16 Vehicles, delivery systems, pharmacokinetics, formulation (Part of: 11 Medical treatment)
14 Costing studies; pharmacoeconomics

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