Economic and Clinical Burden Associated With Intensification of Glaucoma Topical Therapy: A US Claims-based Analysis.
Patel Anik R, Schwartz Gail F, Campbell Joanna H, Chen Chi-Chang, McGuiness Catherine B, Multani Jasjit K, Shih Vanessa, Smith Oluwatosin U
AI Summary
Adding more glaucoma drops provides shorter-lasting benefits and significantly increases costs, highlighting the need for more effective, less burdensome treatments.
Abstract
Precis: Incremental addition of intraocular pressure-lowering topical drops is associated with shorter-lasting benefit and higher health-related costs with each additional agent, suggesting a need for new treatment options to improve disease control and reduce treatment burden.
Purpose
The purpose of this study was to evaluate treatment intensification as a driver of clinical and economic burden in patients receiving topical glaucoma medications for open-angle glaucoma/ocular hypertension.
Methods
This retrospective analysis of administrative claims data (January 2011 to July 2017) from the IQVIA PharMetrics Plus database included diagnosed patients who initiated or intensified treatment with 1 to 4 topical glaucoma medications of a different drug class between January 2012 and July 2015 (index date being the first such event during this period). Patients with prior open-angle glaucoma surgery or an equal or greater number of topical glaucoma medication classes during the preindex period were excluded. Treatment intensification rates and eye-related outpatient costs were assessed over 24 months postindex.
Results
Of 48,402 patients (mean age: 61.4 y), 22,874 (47.3%), 16,214 (33.5%), 7137 (14.7%), and 2177 (4.5%) received a first, second, third, or fourth medication class, respectively, as their first observed initial or intensified regimen. Among cohorts receiving 1, 2, 3, or 4 medication classes, 7.8%, 12.2%, 17.2%, and 22.6% of patients and 12.6%, 18.5%, 25.9%, and 33.7% of patients had subsequent treatment augmentation (class addition or glaucoma procedure, laser or surgical) within 12 and 24 months postindex, respectively. Eye-related outpatient costs over 24 months increased with each additional topical glaucoma medication class at index [mean (SD): $1610 ($3460), $2418 ($4863), $2872 ($5110), and $3751 ($6608) in the 1, 2, 3, or 4 class cohorts, respectively].
Conclusion
Multiple-drop therapies yielded shorter-lasting benefits with each additional agent and were associated with the increased clinical and economic burden.
MeSH Terms
Shields Classification
Key Concepts4
Among patients with open-angle glaucoma/ocular hypertension receiving 1, 2, 3, or 4 topical glaucoma medication classes, 7.8%, 12.2%, 17.2%, and 22.6% respectively, had subsequent treatment augmentation (class addition or glaucoma procedure, laser or surgical) within 12 months post-index.
Among patients with open-angle glaucoma/ocular hypertension receiving 1, 2, 3, or 4 topical glaucoma medication classes, 12.6%, 18.5%, 25.9%, and 33.7% respectively, had subsequent treatment augmentation (class addition or glaucoma procedure, laser or surgical) within 24 months post-index.
Eye-related outpatient costs over 24 months increased with each additional topical glaucoma medication class at index, with mean (SD) costs of $1610 ($3460) for 1 class, $2418 ($4863) for 2 classes, $2872 ($5110) for 3 classes, and $3751 ($6608) for 4 classes in patients with open-angle glaucoma/ocular hypertension.
Multiple-drop therapies for open-angle glaucoma/ocular hypertension yielded shorter-lasting benefits with each additional agent and were associated with increased clinical and economic burden.
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