Glaucoma Consultants, Greater Baltimore Medical Center, Baltimore, Maryland 21204, USA.
J Ocul Pharmacol Ther. 2009 Dec;25(6):555-61. doi: 10.1089/jop.2009.0057.
To develop a model to estimate and compare the cost of changing therapy due to hyperemia in glaucoma patients treated initially either with latanoprost, bimatoprost, or travoprost monotherapy.
Data collected from the HealthCore Integrated Research Database, as part of the Glaucoma Adherence and Persistency Study (GAPS), were used to populate the model. Patients with a documented diagnosis of glaucoma who were newly treated (no ocular hypotensive medication and no glaucoma-related procedure during 6 months before first prescription) with latanoprost, bimatoprost, or travoprost monotherapy were identified. The time horizon for the base-case model was the duration of chart abstraction (mean = 4.1 years); a 3-month model also was developed. Physician-reported rates of hyperemia were obtained from chart reviews of 300 patients. Transition rates reflected events related to reports of hyperemia where a physician-driven change (switch or discontinuation) in therapy was documented. The per-patient direct cost (2008) due to hyperemia-driven change in therapy was calculated as the sum of the cost of the initial prescription plus the cost of the office visit where the patient was evaluated and the decision to change therapy was made. Costs were stratified by whether patients were hyperemia free or discontinued the initial therapy due to hyperemia.
From the sample of 13,977 newly treated patients, 8,743 patients were started on a prostaglandin monotherapy only. Of these, 5,726 received latanoprost, 1,633 were treated with bimatoprost, and 1,384 received travoprost index monotherapy. Across all treatment groups, costs among hyperemia-free patients were US$73.67 versus US$140.02 for those who discontinued the initial prostaglandin due to hyperemia. Per-patient costs were lowest in the group treated initially with latanoprost. For the base-case model, with latanoprost as the reference, total per-patient incremental costs due to hyperemia-driven change in therapy were US$5.92 for bimatoprost and US$5.43 for travoprost. Results were not highly sensitive to increases either in the incidence of hyperemia among latanoprost-treated patients or in the cost of latanoprost.
Hyperemia results in increased overall costs in patients treated with latanoprost, bimatoprost, and travoprost. Treatment with latanoprost is associated with lower hyperemia-related costs than treatment with bimatoprost or travoprost.
开发一种模型来估计和比较因青光眼患者充血而改变治疗方案的成本，这些患者最初分别接受拉坦前列素、贝美前列素或曲伏前列素单药治疗。
从 HealthCore 综合研究数据库中收集的数据，作为青光眼依从性和持久性研究（GAPS）的一部分，用于填充模型。确定了有记录的青光眼诊断且新接受治疗（在首次处方前 6 个月内无眼部降压药物治疗和无青光眼相关手术）的患者，他们接受拉坦前列素、贝美前列素或曲伏前列素单药治疗。基础模型的时间范围为图表摘录的持续时间（平均值=4.1 年）；还开发了一个 3 个月的模型。从 300 名患者的病历回顾中获得了医生报告的充血发生率。过渡率反映了与报告的充血相关的事件，其中记录了因充血而导致的治疗方案改变（换药或停药）。由于充血导致的治疗方案改变而产生的每位患者的直接费用（2008 年）计算为初始处方费用加上评估患者并决定改变治疗方案的就诊费用之和。根据患者是否无充血或因充血而停止初始治疗对成本进行分层。
从新治疗的 13977 名患者中，8743 名患者仅接受前列腺素单药治疗。其中，5726 名患者接受拉坦前列素治疗，1633 名患者接受贝美前列素治疗，1384 名患者接受曲伏前列素指数单药治疗。在所有治疗组中，无充血患者的费用为 73.67 美元，而因充血而停止初始前列腺素治疗的患者费用为 140.02 美元。在最初接受拉坦前列素治疗的患者中，每位患者的费用最低。对于基础模型，以拉坦前列素为参照，由于充血导致的治疗方案改变的每位患者的总增量成本，贝美前列素为 5.92 美元，曲伏前列素为 5.43 美元。当增加拉坦前列素治疗患者的充血发生率或拉坦前列素的成本时，结果并不高度敏感。
充血会导致接受拉坦前列素、贝美前列素和曲伏前列素治疗的患者的总体成本增加。与接受贝美前列素或曲伏前列素治疗相比，接受拉坦前列素治疗与较低的充血相关成本相关。
