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ABSTRACT
Introduction: Innovative drugs have been approved in ophthalmology. Thus, the number and importance of economic evaluation studies of ophthalmic drugs have been growing. This study aims to assess the methodological quality of pharmacoeconomic studies of ophthalmic drugs.
Areas covered: A systematic search was conducted in Pubmed/Embase until November 2018 to identify full pharmacoeconomic studies evaluating ophthalmic drugs. The quality of studies was evaluated using the British Medical Journal (BMJ) checklist. Quality indicators were evaluated by Fisher’s exact test. Ninety-five studies were included, 50 (52.6%) cost-utility analysis, 28 (29.5%) cost-effectiveness and 17 (17.9%) cost-effectiveness/cost-utility. All studies presented, at least, three methodological limitations. Cost-utility studies, studies conducted from a health system perspective, with time horizons longer than one-year and that rely on observational or observational and experimental data simultaneously are associated with higher quality. Only eight (8.4%) studies considered two eyes in the economic analysis and only 13 (13.7%) considered the natural history of the disease when extrapolating results for long-term analysis.
Expert opinion: The majority of the pharmacoeconomic studies were assessed as having good methodological quality, however, the methodological quality scores were sensitive to several indicators. Therefore, improving the quality of studies would enhance their usefulness in the decision-making processes.
Article highlights
Pharmacoeconomic evaluations should be based on the most robust and updated data as well as techniques in order to provide the basis for reliable decision-making processes.
The growth and aging of world population have led to an increase in the number of people suffering from moderate to severe eye disorders. This higher prevalence allied to the expensive treatment costs results in a significant economic impact on the health-care systems.
This systematic review aims to identify and characterize the pharmacoeconomic studies of ophthalmic drugs and to assess their methodological quality.
A systematic literature search was conducted on Pubmed and Embase to identify pharmacoeconomic studies of ophthalmic drugs. The methodological quality of studies was evaluated according to the BMJ checklist, and the Fisher’s exact test was used to identify quality indicators.
Ninety-five studies met the inclusion criteria, comprising 50 (52.6%) cost-utility analysis, 28 (29.5%) cost-effectiveness analysis and 17 (17.9%) cost-effectiveness and cost-utility analysis.
Markov model was the most adopted among ophthalmic economic studies (n = 39; 41.1%). Around 50% ase (n = 13; 13.7%) and sustained benefit effect (n = 13; 13.7%).
Based on the BMJ checklist, all studies presented, at least, one methodological limitation and the majority (n = 53; 55.8%) scored between 5 and 9.5. Studies conducting a cost-utility or simultaneously cost-utility and cost-effectiveness analysis, conducted from a health system perspective, with time horizons longer than one year, that rely on observational data or observational and experimental data simultaneously, which described the type of model, presented statistical analyses and report the sensitivity analysis approach are associated with higher methodological quality scores.
Patient-level simulation models, two-eye analysis and extrapolation based on the natural progression of the disease after treatment ends or on a sustained effect while keeping treatment appear to be suitable choices to apply in future economic studies in the field of ophthalmology.
The use of reporting checklists (such as CHEERS) could improve the reporting of pharmacoeconomic studies, once it is fundamental that a study intending to have good methodological quality could be reported in a comprehensive way.
Improving the quality of pharmacoeconomic studies will enhance their rigor and usefulness in the decision-making processes.
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
A reviewer on this manuscript has disclosed that a small number of their papers were included in the findings of this review. Their employer has, in the past, received funding for some of the studies that were included in the results of the review. They do not have any direct financial conflicts of interest. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.
Supplementary material
Supplemental data for this article can be accessed here.