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Editors Selection IGR 11-2
Cost Effectiveness Review
Comment by Steve Kymes on:
24377 A critical review of the full economic evaluations of pharmacological treatments for glaucoma, Koleva D; De Compadri P; Virgili G et al., Journal of Medical Economics, 2008; 11: 719-741
The marketing of glaucoma medications has spawned a plethora of publications as manufacturers and their clinical advocates sought to gain even the smallest advantage over competitors. This is nowhere more true than in the field of economic evaluation, where there has been an explosion of publications claiming to estimate the economic burden of glaucoma, or to establish the cost-effectiveness of one medication over another. Koleva et al. (1333) have undertaken the task of conducting a rigorous systematic review of this literature and not surprisingly found it lacking in quality. Specifically, they criticize the authors for presenting studies that lack firm clinical sources, relevant measures of outcome, and transparency in structure. Not surprisingly, they caution public health authorities against establishing health policy based upon such evidence. It is important however to note that their search strategy, by focusing on drug comparisons might have resulted in a number of papers that might have met the quality standards sought by the authors, including a report by the Ocular Hypertension Treatment Study team (Kymes et al., AJO, June 2006). This is not to heap self-serving praise upon the OHTS report, which has its own limitations, but to point out that while the authors concerns are quite justified, the field of glaucoma research has benefited of late from the attention of a number of economic investigators, including Rein (Ophthalmology, May 2009) and Berensen (Journal of Glaucoma, June/July 2009). Thus while Dr. Koleva and her colleagues are correct to express concern regarding the past economic investigations, we might be optimistic that similar reviews conducted in the future will result in substantially different findings concerning the quality of this literature.
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