Plosker Greg L, Keam Susan J
Adis International Limited, Auckland, New Zealand.
Pharmacoeconomics. 2006;24(3):297-314. doi: 10.2165/00019053-200624030-00010.
Bimatoprost (Lumigan) is a prostamide analogue used for the reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension. In comparative clinical trials of up to 1 year in duration, administration of 0.03% bimatoprost ophthalmic solution once daily was more effective than 0.5% timolol twice daily and at least as effective as the prostaglandin analogues 0.005% latanoprost and 0.004% travoprost once daily in terms of reducing IOP and/or achieving target IOP levels. Bimatoprost was also more effective than twice-daily administration of 0.5%/2% timolol/dorzolamide in patients refractory to topical timolol therapy. Although generally well tolerated, bimatoprost is associated with a higher incidence of conjunctival hyperaemia than latanoprost, timolol or the combination of timolol and dorzolamide. Three fully published modelled cost-effectiveness analyses of bimatoprost evaluating cost per treatment success in patients with glaucoma or ocular hypertension have been conducted in the US. The analyses incorporated results of randomised, multicentre clinical trials and used a 1-year time horizon. In the treatment algorithm used in the models, patients not achieving target IOP levels with bimatoprost or comparator required additional medical visits and adjunctive therapy. Bimatoprost was associated with lower costs per treatment success than latanoprost, timolol or timolol/dorzolamide across a range of clinically relevant target IOPs. Results were sensitive to changes in treatment success rates and/or drug acquisition costs. Along with the inherent limitations of economic models, other possible criticisms of the analyses are the use of selected IOP data, and the lack of inclusion of costs associated with conjunctival hyperaemia or other adverse effects of therapy. Various other cost-effectiveness analyses of bimatoprost are available, primarily as abstracts and/or posters. In general, most of these studies have also been favourable for bimatoprost, despite having been conducted in different countries and/or from different perspectives. In conclusion, in patients with open-angle glaucoma or ocular hypertension, bimatoprost is an effective and generally well tolerated therapeutic option, albeit with a relatively high incidence of conjunctival hyperaemia. Although results of modelled cost-effectiveness analyses should be interpreted with due consideration of the limitations of the studies, available pharmacoeconomic data generally support the use of bimatoprost as a cost-effective treatment in this patient population.
比马前列素（卢美根）是一种前列腺酰胺类似物，用于降低开角型青光眼或高眼压症患者的眼压升高。在长达1年的比较性临床试验中，每日一次给予0.03%比马前列素滴眼液在降低眼压和/或达到目标眼压水平方面比每日两次给予0.5%噻吗洛尔更有效，并且至少与每日一次给予前列腺素类似物0.005%拉坦前列素和0.004%曲伏前列素效果相当。在对局部噻吗洛尔治疗无效的患者中，比马前列素也比每日两次给予0.5%/2%噻吗洛尔/多佐胺更有效。尽管比马前列素通常耐受性良好，但与拉坦前列素、噻吗洛尔或噻吗洛尔与多佐胺联合用药相比，其结膜充血的发生率更高。在美国已经进行了三项关于比马前列素的全面发表的模型成本效益分析，评估青光眼或高眼压症患者每次治疗成功的成本。这些分析纳入了随机多中心临床试验的结果，并采用了1年的时间范围。在模型中使用的治疗算法中，使用比马前列素或对照药未达到目标眼压水平的患者需要额外就诊和辅助治疗。在一系列临床相关的目标眼压水平上，比马前列素每次治疗成功的成本低于拉坦前列素、噻吗洛尔或噻吗洛尔/多佐胺。结果对治疗成功率和/或药品采购成本的变化敏感。除了经济模型固有的局限性外，对这些分析的其他可能批评是使用了选定的眼压数据，以及未纳入与结膜充血或治疗的其他不良反应相关的成本。还有各种其他关于比马前列素的成本效益分析，主要以摘要和/或海报形式呈现。总体而言，尽管这些研究在不同国家和/或从不同角度进行，但大多数研究对比马前列素也有利。总之，对于开角型青光眼或高眼压症患者，比马前列素是一种有效且通常耐受性良好的治疗选择，尽管结膜充血的发生率相对较高。尽管在考虑研究局限性的情况下应解读模型成本效益分析的结果，但现有的药物经济学数据总体上支持将比马前列素用作该患者群体的成本效益治疗药物。
