Cost-effectiveness of glaucoma management with monotherapy medications in Egypt

Abstract

Glaucoma is a serious chronic ophthalmic disease since it causes irreversible visual disability if untreated can lead to blindness. Treatment options include medications (classified into five major classes of drugs which are muscarinic cholinergic agonists, alpha-2 adrenergic agonists, beta-1 adrenergic antagonists, prostaglandins [PGs], and carbonic anhydrase inhibitors); use of laser therapy or conventional surgery. Pharmacoeconomic analysis helps in choosing among this variety of treatments. There is a great need for such analysis in Egypt since undergoing of it in different countries or societies may produce different results. This work aimed to compare cost-effectiveness of bimatoprost 0.03% once daily versus brimonidine 0.2% twice daily and timolol 0.5% twice daily as monotherapy treatment in Egyptian patients with open-angle glaucoma or ocular hypertension. Clinical data revealed that all treatments decreased intraocular pressure (IOP) significantly but bimatoprost 0.03% showed the highest efficacy (27.7% decrease in IOP from baseline), while timolol 0.5% reduced IOP by 22.5% then brimonidine 0.2% which decreased IOP by 20.8%. From the cost-effectiveness view, it would be preferable to initiate treatment with timolol in case of absence of any contraindications. PG analog can be used as add-on therapy in low responder patients or as alternative treatment in case of presence of contraindication to use of beta blockers.

Changes of the Types and Daily Costs of Topical Antiglaucoma Medications from 2006 to 2021 in China

“…PGAs increased from 3 types (2006) to 10 types (2021), accounting for the largest proportion (31.25%) of all the topical antiglaucoma medications. Among the monotherapy medications, PGAs could achieve the highest reduction of IOP with the less daily usage frequency and systemic side efects and were considered as the initial treatment though expensive in some countries [11][12][13]. Following the PGAs, β-adrenergic blockers comprised 28.12% of the glaucoma medications, which once had the most choices (44%) in 2006 [9].…”

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

“…In a similar study by El-Khamery AA-E et al, in 2017, cost effectiveness of timolol was more favorable (Egyptian pounds 1525.33/ % reduction in IOP) ascompared to brimonidine (Egyptian pounds 4298.08/ % reduction in IOP). [39] Many factors are considered by the physicians while prescribing for the patients of glaucoma. The ultimate goal of the health care providers is to give best, cost effective medicine to the patients and also considering the efficacy, tolerability and response and compliance to the medicine.…”

Keratoconus with Central Serous Chorioretinopathy: A Rare Combination

“…Beta blockers are not the most potent medication of IOP lowering, but they are efficacious, well tolerated by most patients and a low cost-effective choice, making them a good choice as a first-line agent in case of the absence of any contraindications. They induce b receptor blockage which lowers aqueous humor formation and secretion especially during daytime [ 9 , 10 ]. Timolol is one of the most popular and prescribed antiglaucoma beta blocker agents, as a first-line drug in most forms of open angle glaucoma and ocular hypertension [ 11 ].…”