Long-term Medical Management of Primary Open-Angle Glaucoma and Ocular Hypertension in the UK

Orme, Michelle; Collins, Sarah; Loftus, Jane

doi:10.1097/ijg.0b013e31821dac2a

Cited by 12 publications

(8 citation statements)

References 104 publications

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“…Among PGAs, we focused on latanoprost, the most frequently prescribed formulation, because of its high tolerability and the lesser number of side effects associated with its use [7]. Despite its potency, various adverse events have been associated with the presence of BAK in latanoprost formulation [5e7].…”

Section: Discussionmentioning

confidence: 99%

Tear cytokine profile of glaucoma patients treated with preservative-free or preserved latanoprost

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Tear cytokine profile of glaucoma patients treated with preservative-free or preserved latanoprost

et al. 2017

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“…This approach has also been used in other studies in which the mean annual cost per patient was below £500 [ 60 , 61 ]. Some studies have addressed the cost of specific treatment strategies, such as medical management vs trabeculectomy [ 62 ], different medical management strategies [ 63 ], observation only vs medical therapy or laser treatment [ 64 ], or different treatment targets for IOP and visual field measurement frequencies [ 65 ]. A small number of studies have considered the impact of treatment setting on cost [ 66 , 67 ].…”

Section: Resultsmentioning

confidence: 99%

Systematic Literature Review of Clinical and Economic Outcomes of Micro-Invasive Glaucoma Surgery (MIGS) in Primary Open-Angle Glaucoma

2018

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IntroductionPrimary open-angle glaucoma is estimated to affect 3% of the population aged 40–80 years. Trabeculectomy is considered the gold standard in surgical management of glaucoma; however, it is a technically complex procedure that may result in a range of adverse outcomes. Device-augmented, minimally invasive procedures (micro-invasive glaucoma surgeries, MIGS) have been developed aiming for safer and less invasive intraocular pressure (IOP) reduction compared with traditional surgery.MethodsThis paper presents results from a systematic literature review conducted in accordance with National Institute for Health and Care Excellence requirements for the Medical Technology Evaluation Programme via multiple databases from 2005 to 2016. For clinical outcomes, randomized clinical trials (RCTs) comparing MIGS with trabeculectomy or other therapies, observational studies, and other non-RCTs were included. Clinical outcomes reviewed were the change from baseline in mean IOP levels and change in topical glaucoma medication. Safety was assessed by reported harm and adverse events. For economic evidence, trials on cost-effectiveness, cost-utility, cost-benefit, cost-consequences, cost-minimization, cost of illness, and specific procedure costs were included. Risk of bias was assessed for clinical studies using the Cochrane Risk of Bias tool.ResultsA total of nine RCTs (seven iStents®, one Hydrus®, and one CyPass®), seven non-RCTs (three iStent®, three CyPass®, and one Hydrus®), and 23 economic studies were analyzed. While various forms of trabeculectomy can achieve postoperative IOP of between 11.0 and 13.0 mmHg, MIGS devices described in this review were typically associated with higher postoperative IOP levels. In addition, MIGS devices may result in increased hypotony rates or bleb needling in subconjunctival placed devices, requiring additional medical resources to manage. There is limited available evidence on the cost-effectiveness of MIGS and therefore it remains unclear whether the cost of using MIGS is outweighed by cost savings through decreased medication and need for further interventions.ConclusionLarger randomized trials and real-world observational studies are needed for MIGS devices to better assess clinical and economic effectiveness. Given the shortage of published data and increasing use of such procedures, living systematic reviews may help to provide ongoing and timely evidence-based direction for clinicians and decision makers. This review highlights the current unmet need for treatments that are easy to implement and reduce long-term IOP levels without increasing postoperative aftercare and cost.FundingSanten GmbH, Germany.Electronic supplementary materialThe online version of this article (10.1007/s40123-018-0131-0) contains supplementary material, which is available to authorized users.

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“…However, prostaglandin cost is reported to be offset by fewer clinic visits for switches, and by avoiding surgery or costs associated with managing low vision. [ 14 ] Pilocarpine which is a cheap, effective and comfortable alternative, should be utilized especially in cases of angle closure glaucoma and should be made available in developing countries. The availability of quality controlled generic drugs may make a significant impact to the cost of medical therapy.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomics of long-term glaucoma therapy in India

Nayak

Gupta

Kumar

et al. 2015

Indian J Ophthalmol

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Purpose:To determine the socioeconomic impact of long-term glaucoma therapy.Materials and Methods:One hundred and fifty consecutive glaucoma patients on medical therapy, following up at our glaucoma service for at least 6 months were recruited. A questionnaire regarding monthly income, cost of glaucoma medications prescribed, availability of medications, travel time, time spent in review clinics, compliance, education status, medical insurance and systemic or local side-effects was administered.Results:The patients seen at the tertiary government hospital had an average monthly income of Rs. 10,912/- (range: Rs. 500/- to Rs. 50,000/-) with approximately 56% of the patients having an income of less than Rs. 5000/month. The expenditure on anti-glaucoma medications ranged from 0.3% in high income group to 123% of their monthly gross income in low income group (P < 0.0001). The total expenditure including travel, stay, and loss of wages of patients and accompanying persons ranged from 1.6% in high income group to 137% of the monthly income in low income group (P < 0.0001). Mean time required for a glaucoma clinic visit was 15.66 h, (range: 6–96 h/month). About 2.7% experienced systemic side-effects and 21.3% had complaints of ocular adverse effects. About 90% of the patients were compliant. 92% were not covered by any insurance plan/government reimbursement for their treatment.Conclusions:Medical therapy for glaucoma is an economic burden to many patients and should be individualized, according to the socioeconomic status, availability of drugs and the required distance to travel to reach the specialist clinics.

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Long-term Medical Management of Primary Open-Angle Glaucoma and Ocular Hypertension in the UK

Cited by 12 publications

References 104 publications

Tear cytokine profile of glaucoma patients treated with preservative-free or preserved latanoprost

Tear cytokine profile of glaucoma patients treated with preservative-free or preserved latanoprost

Systematic Literature Review of Clinical and Economic Outcomes of Micro-Invasive Glaucoma Surgery (MIGS) in Primary Open-Angle Glaucoma

Socioeconomics of long-term glaucoma therapy in India

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