Christensen Torsten Lundgaard, Poulsen Peter Bo, Holmstrom Stefan, Walt John G, Vetrugno Michele
Muusmann Research & Consulting, Kolding, Denmark.
Curr Med Res Opin. 2005 Nov;21(11):1837-44. doi: 10.1185/030079905X65592.
Glaucoma is generally managed by decreasing the intraocular pressure (IOP) to a level believed to prevent further damage to the optic disc and loss of visual field. This may be achieved medically or surgically. The objective of this pharmacoeconomic analysis was to investigate the 4-year costs of bimatoprost 0.03% (Lumigan) eye drops as an alternative to filtration surgery (FS) for glaucoma patients on maximum tolerable medical therapy (MTMT).
A Markov model was designed using effectiveness and resource use data from a randomized clinical trial and expert statements (Delphi panel). The RCT covered 83 patients on MTMT. The Model compared bimatoprost with FS. In the bimatoprost model arm patients began treatment with bimatoprost. If target IOP (-20%) was not reached using medical therapy the patient proceeded with FS. In the FS model arm, FS was performed after the first ophthalmologist visit. Unit costs were obtained from an Italian chart and tariffs review (healthcare sector perspective).
The RCT showed that 74.7% of the patients delayed the need for FS by 3 months. The Markov model forecasted that 64.2% of the patients could delay the need for FS by 1 year, and forecasted 34.0% could avoid FS after 4 years. The 4-year cost per patient in the bimatoprost and FS arms was E3438 and E4194, respectively (incremental costs of E755). The major cost drivers for the bimatoprost arm were patients who needed combination therapy or FS if the target IOP was not reached. In the FS arm, the major cost drives were the initial surgery costs and pressure-lowering medications used as add-on therapy after FS.
The analysis shows that in a 4-year perspective bimatoprost is cheaper compared to FS. In addition, the postponement of FS associated with bimatoprost may have important implications for waiting list planning.
青光眼的治疗通常是将眼压降低到一个被认为可防止对视盘造成进一步损害和视野丧失的水平。这可以通过药物或手术实现。本药物经济学分析的目的是研究0.03%比马前列素（卢美根）滴眼液作为青光眼患者在最大耐受药物治疗（MTMT）下替代滤过手术（FS）的4年成本。
使用来自一项随机临床试验的有效性和资源使用数据以及专家意见（德尔菲小组）设计了一个马尔可夫模型。该随机对照试验涵盖了83名接受MTMT的患者。该模型将比马前列素与FS进行了比较。在比马前列素模型组中，患者开始使用比马前列素治疗。如果使用药物治疗未达到目标眼压（降低20%），患者则进行FS。在FS模型组中，在首次眼科医生就诊后进行FS。单位成本来自意大利的一份图表和费率审查（从医疗保健部门角度）。
随机对照试验表明，74.7%的患者将FS需求推迟了3个月。马尔可夫模型预测，64.2%的患者可将FS需求推迟1年，且预测34.0%的患者在4年后可避免FS。比马前列素组和FS组每位患者的4年成本分别为3438欧元和4194欧元（增量成本为755欧元）。比马前列素组的主要成本驱动因素是如果未达到目标眼压则需要联合治疗或FS的患者。在FS组中，主要成本驱动因素是初始手术成本以及FS后作为附加治疗使用的降压药物。
分析表明，从4年的角度来看，比马前列素比FS更便宜。此外，与比马前列素相关的FS推迟可能对等候名单规划具有重要意义。
