International Journal of Medical and Dental Sciences

Open Access Open Access  Restricted Access Subscription Access

A Pharmacoeconomic Analysis to Determine the Relative Cost-effectiveness of Timolol 0.5%, Brinzolamide 1% and Brimonidine 0.2% Eye Drops in Treatment of Primary Open Angle Glaucoma/Ocular Hypertension


Affiliations
1 Department of Pharmacology, BFUHS, GMC Patiala – 147001, Punjab, India
2 Department of Ophthalmology, BFUHS, GMC Patiala – 147001, Punjab, India
 

Aim: A pharmacoeconomic analysis to determine the relative cost-effectiveness of timolol 0.5%, brinzolamide 1% and brimonidine 0.2% eye drops in treatment of Primary Open Angle Glaucoma (POAG)/ocular hypertension (OHT). Settings and Design: Comparative, open, randomized, parallel group prospective study. Materials and Methods: 60 patients of POAG or ocular hypertension were included in this study. Time period of study was 6 weeks. 60 eyes of 60 patients were included in the study. Patients were divided randomly into 3 groups of 20 each. Patients in group A, B and C received timolol, brinzolamide and brimonidine respectively. One drop of each medication was instilled twice a day at 9 am and 9 pm daily for 6 weeks. IOP was measured on day 0 at 9 am (before administration of drugs) and then at 11 am, to get baseline IOP. IOP was again measured on subsequent visits at 9 am and 11 am. Treatment outcome was number of mm Hg fall in IOP induced by the study drug. The daily cost of each drug was calculated by maximum retail price and the average number of drops per bottle. The cost‑effectiveness was then calculated as the cost of drug/mm Hg fall in IOP. Statistics: Paired ‘t’ test was used to analyze the parameters within the group. Independent samples t‑test was used to compare the efficacy of drugs with each other. Results: The % reduction of brimonidine, timolol and brinzolamide at end of 6 weeks was 21.43 ± 3.06%, 24.87 ± 2.46% and 18.78 ± 1.73% respectively. Timolol was superior in efficacy to other two drugs. The difference was statistically significant between the efficacy of timolol and brinzolamide (p < 0.001) as well as timolol and brimonidine (p = 0.003). There was no statistical significant difference in the efficacy of brimonidine when compared to brinzolamide (p=0.26). Timolol (5.87 ± 0.83 Rs/mm lowering after 6 weeks) was found to be most cost-effective followed by brimonidine (46.83 ± 7.37) and then brinzolamide (60.49 ± 6.77) in lowering IOP. Conclusion: All three drugs under the present study are useful in the treatment of POAG/OHT, but timolol is a better choice than other two drugs because of greater reduction in IOP and greater cost-effectiveness.

Keywords

Cost-Effectiveness, Glaucoma, Pharmacoeconomics, POAG.
User
Notifications
Font Size


  • Jothi R, Ismail AM, Senthamarai R, Pal S. A comparative study on the efficacy, safety, and cost-effectiveness of bimatoprost/timolol anddorzolamide/timolol combinations in glaucoma patients. Indian JPharmacol. 2010; 42:362–5. https://doi.org/10.4103/0253-7613.71917 PMid:21189906 PMCid:PMC2991693

  • Schmidl D, Schmetterer L, Garhöfer G, Popa-Cherecheanu A. Pharmacotherapy of Glaucoma. J Ocul Pharmacol Ther. 2015; 31(2):63–77. https://doi.org/10.1089/jop.2014.0067 PMid:25587905 PMCid:PMC4346603

  • Stamper RL, Lieberman MF, Drake MV. Introduction and classification of Glaucomas. In: Diagnosis and Therapy of Glaucomas. 8th ed. China: Elsevier; 2009. p. 1–3. https://doi.org/10.1016/B978-0-323-02394-8.00001-2

  • Malihi M, MouraFilho ER, Hodge DO, Sit AJ. Long-Term Trends in Glaucoma-Related Blindness in Olmsted County, Minnesota. Ophthalmology. 2014; 121(1):134–41. https://doi.org/10.1016/j.ophtha.2013.09.003 PMid:24823760 PMCid:PMC4038428

  • Saxena R, Singh D, Vashist. Glaucoma: An emerging peril. Indian J Community Med. 2013; 38:135-7. https://doi.org/10.4103/0970-0218.116348 PMid:24019597 PMCid: PMC3760320

  • Alligham R. Introduction: An overview of glaucoma. In: Alligham R, Damji K editors. Shields Textbook of Glaucoma. 6th ed. USA: Lippincott Williams and Wilkins; 2011 .p. 3–8.

  • Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: A systematic review and metaanalysis. Ophthalmology. 2014; 121(11):2081–90. https://doi.org/10.1016/j.ophtha.2014.05.013 PMid:24974815

  • Park K. Park’s textbook of preventive and social medicine. 23rd ed. Jabalpur: Banarasidasbhanot; 2015 .p. 402.

  • Kanski J, Bowling B, Nischal K, Pearson A. Clinical ophthalmology. 7th ed. China: Elsevier Saunders; 2011 .p. 313.

  • Mansukani S. On managed care’s doorstep, glaucoma. P & T Digest. 2002; 11(Suppl 11):S6–10.

  • Weinreb RN, Leung CK, Crowston JG, Medeiros FA, Friedman DS, Wiggs JL et al. Primary open-angle glaucoma. Nat Rev Dis Primers. 2016; 2:1–19. https://doi.org/10.1038/nrdp.2016.67 PMid:27654570

  • Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Globalprevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and metaanalysis. Ophthalmology. 2014;121(11):2081–90. https://doi.org/10.1016/j.ophtha.2014.05.013 PMid:24974815

  • Tielsch JM, Sommer A, Katz J, Royall RM, Quigley HA, Javitt J. Racialvariations in the prevalence of primary open-angle glaucoma. The Baltimore Eye Survey. JAMA. 1991; 266(3):369–74. https://doi.org/10.1001/jama.1991.03470030069026 PMid:2056646

  • Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br. J. Ophthalmol. 2006; 90:262–7. https://doi.org/10.1136/bjo.2005.081224 PMid:16488940 PMCid:PMC1856963

  • Robert LS, Marc FL, Michael VD. Becker-Shaffer’s diagnosis and therapy of the glaucomas. 8 ed. China: Elsevier; 2009. p. 1. PMid:19161663

  • Leske MC, Heijl A, Hussein M, Bengtsson B, Hyman L, Komaroff E, et al. Factors for glaucoma progression and the effect of treatment: The earlymanifest glaucoma trial. Arch Ophthalmol. 2003; 121:48–56. https://doi.org/10.1001/archopht.121.1.48 PMid:12523884

  • Henderer JD, Rapuano CJ. Ocular Pharmacology. In: Brunton LL, Chabner BA, Knollmann BC, editors. Goodman and Gillman’s the Pharmacological Basis of Therapeutics. 12th ed. New York: McGraw Hill; 2011. p. 1785–8.

  • Barlett JD, Fiscella RG, Jaanus SD, Barnebey H. Ocular hypotensivedrugs. In: Bartlett JD, Jaanus SD, editors. Clinical ocular pharmacology. 5th ed. United States of America: Butterworth Heinemann Elsevier; 2008. p.145– 66. https://doi.org/10.1016/B978-0-7506-7576-5.50015-X

  • Katz LJ. Brimonidine tartrate 0.2% twice daily vs timolol 0.5% twice daily:1-year results in glaucoma patients. Am J Ophthalmol. 1999; 127(1):20–6. https://doi.org/10.1016/S0002-9394(98)00286-4

  • Alm A, Stjernschantz J. Effects on intraocular pressure and side effects of 0.005% latanoprost applied once daily, evening or morning. Ophthalmology. 1995; 102(12):1743– 52. https://doi.org/10.1016/S0161-6420(95)30798-1

  • Uusitalo H, Ni-o J, Tahvanainen K, Turjanmaa V, Ropo A, Tuominen J, et al. Efficacy and systemic side-effects of topical 0.5% timolol aqueoussolution and 0.1% timolol hydrogel.Acta Ophthalmol Scand. 2005; 83(6):723–8. https://doi.org/10.1111/j.1600-0420.2005.00562.x PMid:16396651

  • Willis AM, Diehl KA, Robbin TE. Advances in topical glaucoma therapy. Vet Ophthalmol. 2002; 5(1):9–17. https://doi.org/10.1046/j.1463-5216.2001.00202.x PMid:11940242

  • Cvetkovic RS, Perry CM. Brinzolamide a review of its use in the management of primary open-angle glaucoma and ocular hypertension. Drugs Aging. 2003; 20(12):919–47. https://doi.org/10.2165/00002512-200320120-00008 PMid:14565787

  • Mehani R, Yadav VK, Sankadia RK, Ghodki S, Garg T. Pharmacoeconomic analysis of brimonidine/timolol and travoprost 0.004% in the treatment of primary open angle glaucoma in Indian settings. Int J Basic Clin Pharmacol. 2016; 5(2):508–12. https://doi.org/10.18203/2319-2003.ijbcp20160770

  • Gray JA, Larry CW. Evidence-based healthcare: how to make health policy and management decisions. Can Med Assoc J. 1997; 157(11):1598–99.

  • Drummond MF, Richardson S, O’Brien BJ, Levine M, Heyland D. How to use an article on economic analysis of clinical practice: Evidence Based Medicine Working Group. JAMA. 1997; 277:1552–7. https://doi.org/10.1001/jama.1997.03540430064035 PMid:9153371

  • Byford S, Raftery J. Perspectives in economic evaluation. BMJ. 1998; 316:1529–30. https://doi.org/10.1136/bmj.316.7143.1529 PMid:9582152 PMCid:PMC1113167

  • Kobelt G. Health economics, economic evaluation, glaucoma. Journal of Glaucoma. 2002; 11(6):531–9. https://doi.org/10.1097/00061198-200212000-00015 PMid:12483101

  • Robinson R. Cost-benefit analysis. BMJ. 1993; 307:924–6. https://doi.org/10.1136/bmj.307.6909.924 PMid:8241859 PMCid:PMC1679054

  • Narayanaswamy A, Baskaran M, Zheng Y, Lavanya R, Wu R, Wong WL. The prevalence and types of glaucoma in an urban Indian population: the Singapore Indian Eye Study. Invest Ophthalmol Vis Sci. 2013; 54(7):4621–7. https://doi.org/10.1167/iovs.13-11950 PMid:23745009

  • Rylander NR, Vold DS. Cost analysis of glaucoma medications. Am J Ophthalmol. 2008; 145:106-13. https:// doi.org/10.1016/j.ajo.2007.08.041 PMid:18154755

  • Fiscella RG, Green A, Patuszynsk DH, Wilensky J. Medical therapy cost considerations for glaucoma. Am J Ophthalmol. 2003; 136(1):18–25. https://doi.org/10.1016/S0002-9394(03)00102-8

  • Netland PA, Landry T, Sullivan EK, Andrew R, Silver L, Weiner A et al. Travoprost compared with latanoprost and timolol in patients with open-angle glaucoma or ocular hypertension. Am J Ophthalmol. 2001; 132(4):472–84. https://doi.org/10.1016/S0002-9394(01)01177-1

  • Weinreb RN, Sforzolini BS, Vittitow J, Liebmann J. LatanoprosteneBunod 0.024% versus timolol maleate 0.5% in subjects with open-angle glaucoma or ocular hypertension. Ophthalmology. 2016; 123(5):965–73. https:// doi.org/10.1016/j.ophtha.2016.01.019 PMid:26875002

  • Thomas R, Parikh R, Muliyil J, George R, Paul P, Abraham LM. Comparison between latanoprost and brimonidine efficacy and safety in Indian eyes. Indian J Ophthalmol. 2003 Jun; 51(2):123–8. PMid:12831141

  • Realini T, Nguyen QH, Katz G, DuBiner H. Fixedcombination brinzolamide 1%/brimonidine 0.2% vsmonotherapy with brinzolamide or brimonidine in patients with open-angle glaucoma or ocular hypertension: results of a pooled analysis of two phase 3 studies. Eye. 2013; 27:841–7. https://doi.org/10.1038/eye.2013.83 PMid:23640612 PMCid:PMC3709402

  • Silver LH. Clinical efficacy and safety of brinzolamide (Azopt™), a new topical carbonic anhydrase inhibitor for primary open-angle glaucoma and ocular hypertension. Am J Ophthalmol. 1998; 126(3):400–8. https://doi.org/10.1016/S0002-9394(98)00095-6

  • Li T, Lindsley K, Rouse B, Hong H, Shi Q, Friedman DS, et al. Comparative effectiveness of first-line medications for primary open angle glaucoma- A systematic review and network meta-analysis. Ophthalmology. 2016; 123(1):129–40. https://doi.org/10.1016/j.ophtha.2015.09.005 PMid:26526633 PMCid:PMC4695285

  • El-Khamery AA-E, Mohamed AI, Swify HEH, Mohamed AI. Cost-effectiveness of glaucoma management with monotherapy medications in Egypt. J Adv Pharm Technol Res. 2017; 8(1):25–8. https://doi.org/10.4103/22314040.197384 PMid:28217551 PMCid:PMC5288967


Abstract Views: 343

PDF Views: 144




  • A Pharmacoeconomic Analysis to Determine the Relative Cost-effectiveness of Timolol 0.5%, Brinzolamide 1% and Brimonidine 0.2% Eye Drops in Treatment of Primary Open Angle Glaucoma/Ocular Hypertension

Abstract Views: 343  |  PDF Views: 144

Authors

Vijay K. Sehgal
Department of Pharmacology, BFUHS, GMC Patiala – 147001, Punjab, India
Tushar Vashisht
Department of Pharmacology, BFUHS, GMC Patiala – 147001, Punjab, India
Gursatinder Singh
Department of Ophthalmology, BFUHS, GMC Patiala – 147001, Punjab, India
Neetu Sharma
Department of Pharmacology, BFUHS, GMC Patiala – 147001, Punjab, India

Abstract


Aim: A pharmacoeconomic analysis to determine the relative cost-effectiveness of timolol 0.5%, brinzolamide 1% and brimonidine 0.2% eye drops in treatment of Primary Open Angle Glaucoma (POAG)/ocular hypertension (OHT). Settings and Design: Comparative, open, randomized, parallel group prospective study. Materials and Methods: 60 patients of POAG or ocular hypertension were included in this study. Time period of study was 6 weeks. 60 eyes of 60 patients were included in the study. Patients were divided randomly into 3 groups of 20 each. Patients in group A, B and C received timolol, brinzolamide and brimonidine respectively. One drop of each medication was instilled twice a day at 9 am and 9 pm daily for 6 weeks. IOP was measured on day 0 at 9 am (before administration of drugs) and then at 11 am, to get baseline IOP. IOP was again measured on subsequent visits at 9 am and 11 am. Treatment outcome was number of mm Hg fall in IOP induced by the study drug. The daily cost of each drug was calculated by maximum retail price and the average number of drops per bottle. The cost‑effectiveness was then calculated as the cost of drug/mm Hg fall in IOP. Statistics: Paired ‘t’ test was used to analyze the parameters within the group. Independent samples t‑test was used to compare the efficacy of drugs with each other. Results: The % reduction of brimonidine, timolol and brinzolamide at end of 6 weeks was 21.43 ± 3.06%, 24.87 ± 2.46% and 18.78 ± 1.73% respectively. Timolol was superior in efficacy to other two drugs. The difference was statistically significant between the efficacy of timolol and brinzolamide (p < 0.001) as well as timolol and brimonidine (p = 0.003). There was no statistical significant difference in the efficacy of brimonidine when compared to brinzolamide (p=0.26). Timolol (5.87 ± 0.83 Rs/mm lowering after 6 weeks) was found to be most cost-effective followed by brimonidine (46.83 ± 7.37) and then brinzolamide (60.49 ± 6.77) in lowering IOP. Conclusion: All three drugs under the present study are useful in the treatment of POAG/OHT, but timolol is a better choice than other two drugs because of greater reduction in IOP and greater cost-effectiveness.

Keywords


Cost-Effectiveness, Glaucoma, Pharmacoeconomics, POAG.

References





DOI: https://doi.org/10.18311/ijmdsjssmes%2F2019%2F184483