Clinical and Economic Impact of New Trends in Glaucoma Treatment

Albert Marchetti, MD, Raf Magar, Peter An, MS, Mike Nichol, PhD

In This Article

Abstract and Introduction

Context: Glaucoma is a chronic ophthalmic condition affecting approximately 15 million people. Several therapies are currently available (eg, beta-blockers, sympathomimetics, carbonic anhydrase inhibitors) but have side effects that may limit use. Over the last few years, new medications with improved efficacy and side-effect profiles have become available. This analysis evaluates 2 therapies, brimonidine and betaxolol, based on head-to-head clinical trial data to determine clinical consequences and their related expected costs.
Objective: To calculate comparative costs and the cost-effectiveness of brimonidine 0.2% and betaxolol 0.25% as first-line therapy for patients with primary open-angle glaucoma.
Design: Safety, efficacy, effectiveness, and quality-of-life data were collected in a multicenter, randomized, double-blind, head-to-head comparative effectiveness study, with a drug switch possibility. A disease-intervention model (decision tree) was developed with clinicians, academicians, and health economists. Components of care for each pathway in the model were identified and evaluated; their costs were applied at appropriate points throughout the tree. Expected outcomes and costs were computed and compared.
Patients: Participants were men (n = 76) and women (n = 112), 21 years of age or older, with newly diagnosed or currently untreated ocular hypertension or open-angle glaucoma.
Results: The clinical success rates of first-line brimonidine 0.2% and betaxolol 0.25% are 73.9% and 56.2%, respectively, as determined in a head-to-head comparative effectiveness trial. Total expected costs for patients receiving brimonidine and betaxolol as a primary therapy are $301.37 and $328.19, respectively, based on the model. Dividing costs by outcomes, the cost-effectiveness ratios for brimonidine and betaxolol are $407.81 ($301.37/0.739) and $583.97 ($328.19/0.562), respectively, representing the cost/unit outcome, or the cost to achieve clinical success.
Conclusions: Brimonidine 0.2% is less costly and more cost-effective than betaxolol 0.25% when used as initial monotherapy with and without subsequent add-on therapies, including laser treatments and/or surgery, as needed.

In competitive, capitated, and regulated healthcare environments, products and services must be justified clinically as well as economically. They must compare favorably with current standards or acceptable options and should possess attractive cost-benefit ratios. Value must be established in order to gain broad acceptance and utilization from providers and patients, widespread reimbursement from payers, and universal approval from the society at large.

To demonstrate clinical benefit and value of pharmaceutical interventions, safety and efficacy data from clinical trials and observational studies should be analyzed and compared with resource utilization and cost data from actual clinical practice. Disease-intervention models can be used to extend research results to daily practice and to reveal the clinical and economic impact of competitive healthcare interventions in common clinical scenarios. Various health economic methodologies have individual strengths and weaknesses; however, the information that is gained with each study will shed light on the consequences of healthcare decisions so that actions can be taken to improve the efficiency of healthcare service through more intelligent resource utilization.

To establish and compare the value of brimonidine 0.2% (Alphagan) and betaxolol 0.25% (Betoptic - S) as first-line therapy for patients with primary open-angle glaucoma, a head-to-head effectiveness trial was conducted for safety and efficacy as well as overall effectiveness and patient quality of life comparisons.[1] Also, a disease-intervention model depicting common pathways of care was developed to accept data from the trial and to compute total expected costs in natural practice settings when the 2 treatment alternatives are used as initial therapy, with and without adjunctive care.