Tachkov Konstantin, Vassilev Anton, Kostova Stanislava
Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria.
Department of Ophthalmology, Medical University of Sofia, Sofia, Bulgaria.
Front Public Health. 2019 Dec 20;7:363. doi: 10.3389/fpubh.2019.00363. eCollection 2019.
We aimed to analyze and model the cost and results of current outpatient pharmacotherapy practice in patients with primary open-angle glaucoma concomitant with dry-eye disease (POAG+DE). The point of view is that of the health care system and patients, and the time horizon was 1 year. Data were collected through a prospective, observational, real-life study of therapy practice in patients admitted to the specialized ophthalmology clinic at the Alexandrovska University Hospital in Sofia. Pharmacotherapy was recorded and analyzed by therapeutic group and INN. The probability of being prescribed preservative-free or non-free formulations was calculated, as were the cost of yearly therapy, reimbursed cost, and patient co-payment. A decision tree exploring the cost-effectiveness of preservative-free and preservative non-free formulations was built. Outcomes were recorded through three tests measuring tear film stability: TMS, NIBUT Ave, and ST. TMS values below 3, ST above 10 mm, and NIBUT Ave above 14 s were considered as indicators of good disease control. A total of 140 eyes were diagnosed with POAG, of which 64 had concomitant dry-eye disease and were included in the analysis. Monotherapy was prescribed to 34: 14 on preservative-free formulations and 20 on non-free. Meanwhile, 30 eyes received combination therapy: six on preservative-free and 24 on non-free. The monotherapy product was most commonly Prostaglandin Analogs (PG-73.5%), followed by beta-blockers (BB-26.5%). No carbonic anhydrase inhibitors (Ca AA) or alpha-2 adrenergic agonists (alfa 2 AA) were prescribed as monotherapy. The majority of patients showed poor disease control according to all three measures. The incremental cost-effectiveness ratio (ICER) was 744 BGN for TMS and 131 BGN for NUBIT for each successfully controlled eye-far below three times GDP per capita. For ST, the ICER was negative, benefiting non-free formulations. Therapy of POAG+DED with preservative-free formulations is cost-effective according to the WHO threshold of three times GDP. The median costs of the two treatment modalities were similar. Current practice shows that patients experience a higher burden in terms of co-payment than do institutions such as the NHIF.
我们旨在分析和模拟原发性开角型青光眼合并干眼症（POAG+DE）患者当前门诊药物治疗的成本和结果。研究视角为医疗保健系统和患者，时间范围为1年。数据通过对索非亚亚历山德罗斯卡大学医院眼科专科门诊收治患者的治疗实践进行前瞻性、观察性、现实生活研究收集。药物治疗按治疗组和国际非专利药品名称进行记录和分析。计算开具无防腐剂或含防腐剂制剂的概率、年度治疗费用、报销费用和患者自付费用。构建了一个决策树，探讨无防腐剂和含防腐剂制剂的成本效益。通过三项测量泪膜稳定性的测试记录结果：泪膜稳定性测试仪（TMS）、平均泪膜破裂时间（NIBUT Ave）和泪河高度（ST）。TMS值低于3、ST高于10毫米、NIBUT Ave高于14秒被视为疾病控制良好的指标。共有140只眼睛被诊断为POAG，其中64只伴有干眼症并纳入分析。34只眼睛接受单一疗法：14只使用无防腐剂制剂，20只使用含防腐剂制剂。同时，30只眼睛接受联合治疗：6只使用无防腐剂制剂，24只使用含防腐剂制剂。单一疗法最常用的药物是前列腺素类似物（PG - 73.5%），其次是β受体阻滞剂（BB - 26.5%）。没有患者接受碳酸酐酶抑制剂（Ca AA）或α - 2肾上腺素能激动剂（alfa 2 AA）单一疗法。根据所有三项指标，大多数患者疾病控制不佳。每成功控制一只眼睛，TMS的增量成本效益比（ICER）为744保加利亚列弗，NUBIT为131保加利亚列弗，远低于人均国内生产总值的三倍。对于ST，ICER为负，含防腐剂制剂更具优势。根据世界卫生组织人均国内生产总值三倍的阈值，使用无防腐剂制剂治疗POAG+DED具有成本效益。两种治疗方式的中位数成本相似。当前实践表明，患者在自付费用方面的负担高于国家健康保险基金（NHIF）等机构。
