Prostaglandin Analogues for the Treatment of Glaucoma and Ocular Hypertension

Abstract

We conducted a systematic review of economic studies of prostaglandin analogues for the treatment of glaucoma to assess the scope of current cost-effectiveness evidence and its relevance to decision-makers. The literature search retrieved 102 studies published before July 2005; after additional hand searching of conference proceedings, 13 full-text articles and 13 abstracts met the inclusion criteria. The reviewers extracted the key characteristics of each of the economic evaluations, and all studies received a grade in five categories to summarise the quality of the study: methodology, transparency, sensitivity, relevance and overall score. The current economic literature is predominantly focused on identifying the short-term direct cost of glaucoma treatment, particularly the precise quantification of glaucoma drug costs. Using the European and US treatment guidelines as a benchmark, it is evident that the current body of literature does not satisfy the needs of decision-makers, although certain studies provide some valuable information, which is a step towards reaching this goal. The main methodological issue in the economic models is an absence of a clinically relevant long-term effectiveness measure, or where this measure is produced, there is a lack of transparency and validation of the methods used. More attention needs to be given to modelling the consequences of treatment, and those consequences should include patient compliance, control of intraocular pressure and progression of visual field deficit, since these drive both the costs and the overall outcomes. We recognise that constructing the 'ideal' clinical outcome measure represents a major challenge to researchers. As such, we have outlined a modelling framework that could be used to produce the required level of economic evidence, and ongoing clinical research (such as the Early Manifest Glaucoma Trial) could provide the validated link between intraocular pressure and disease progression, which forms an essential part of such models.

Epidemiology of Major Eye Diseases Leading to Blindness in Europe: A Literature Review

“…This can be achieved by using topical and/or oral medications, laser surgery, conventional surgery, or a combination of these therapies [101] . Current health economics studies on glaucoma treatment mostly focus on direct costs of glaucoma drugs, and therefore provide only one component of real glau- coma treatment costs [100,102,103] . The main issue that limits this research in the area of glaucoma treatment is absence of a reliable, transparent and validated long-term effectiveness measure [100] .…”

Intraocular Pressure Response to Medication in a Clinical Setting: The Marshfield Clinic Personalized Medicine Research Project

“…A recent systematic review of prostaglandin analogs for the treatment of glaucoma and ocular hypertension found that the current body of medical literature does not satisfy the needs of medical decision makers, in part because of the absence of clinically relevant long-term effectiveness measures. 15 Further follow-up of this population-based cohort could provide these data in a clinical setting.…”

Cost-effectiveness of screening for open angle glaucoma in developed countries

“…[36] However, with increasing follow-up (up to 8 years) the difference in costs between surgery and medication may even out. The current economic literature regarding glaucoma treatment is predominantly focused on identifying the short-term direct, particularly the precise quantification of glaucoma drug costs[3537] and provide thus only one component of real-world costs for glaucoma.…”