Allergan Inc., Irvine, CA 92612-1599, USA.
Curr Med Res Opin. 2013 Sep;29(9):1191-200. doi: 10.1185/03007995.2013.815159. Epub 2013 Jul 18.
Estimate the long-term direct medical costs and clinical consequences of improved adherence with bimatoprost 0.01% compared to bimatoprost 0.03% in the treatment of glaucoma.
A cost-consequence model was constructed from the perspective of a US healthcare payer. The model structure included three adherence levels (high, moderate, low) and four mean deviation (MD) defined health states (mild, moderate, severe glaucoma, blindness) for each adherence level. Clinical efficacy in terms of IOP reduction was obtained from the randomized controlled trial comparing bimatoprost 0.01% with bimatoprost 0.03%. Medication adherence was based on observed 12 month rates from an analysis of a nationally representative pharmacy claims database. Patients with high, moderate and low adherence were assumed to receive 100%, 50% and 0% of the IOP reduction observed in the clinical trial, respectively. Each 1 mmHg reduction in IOP was assumed to result in a 10% reduction in the risk of glaucoma progression. Worse glaucoma severity health states were associated with higher medical resource costs. Outcome measures were total costs, proportion of patients who progress and who become blind, and years of blindness. Deterministic sensitivity analyses were performed on uncertain model parameters.
The percentage of patients progressing, becoming blind, and the time spent blind slightly favored bimatoprost 0.01%. Improved adherence with bimatoprost 0.01% led to higher costs in the first 2 years; however, starting in year 3 bimatoprost 0.01% became less costly compared to bimatoprost 0.03% with a total reduction in costs reaching US$3433 over a lifetime time horizon. Deterministic sensitivity analyses demonstrated that results were robust, with the majority of analyses favoring bimatoprost 0.01%. Application of 1 year adherence and efficacy over the long term are limitations.
Modeling the effect of greater medication adherence with bimatoprost 0.01% compared with bimatoprost 0.03% suggests that differences may result in improved economic and patient outcomes.
估计与使用比马前列素 0.03%相比，提高比马前列素 0.01%的依从性对治疗青光眼的长期直接医疗成本和临床后果的影响。
从美国医疗保健支付者的角度构建成本-效果模型。模型结构包括三个依从性水平（高、中、低）和四个平均偏差（MD）定义的健康状态（轻度、中度、重度青光眼、失明），每个依从性水平各有 4 个。IOP 降低的临床疗效来自于比较比马前列素 0.01%和比马前列素 0.03%的随机对照试验。药物依从性基于全国代表性药房索赔数据库分析中观察到的 12 个月率。假设高、中、低依从性患者分别接受临床试验中观察到的 IOP 降低的 100%、50%和 0%。假设每降低 1mmHg 的 IOP 可使青光眼进展风险降低 10%。更严重的青光眼严重程度健康状态与更高的医疗资源成本相关。结果测量包括总费用、进展和失明患者的比例以及失明时间。对不确定模型参数进行了确定性敏感性分析。
进展、失明的患者比例以及失明时间稍有利于比马前列素 0.01%。比马前列素 0.01%的依从性提高在前 2 年导致成本增加；然而，从第 3 年开始，比马前列素 0.01%的成本比比马前列素 0.03%低，在终生时间范围内总成本降低 3433 美元。确定性敏感性分析表明，结果是稳健的，大多数分析都倾向于比马前列素 0.01%。在长期内应用 1 年的依从性和疗效是有限制的。
与使用比马前列素 0.03%相比，建模更大程度的药物依从性对比马前列素 0.01%的影响表明，差异可能导致改善的经济和患者结局。
