Two-year treatment patterns and costs in glaucoma patients initiating treatment with prostaglandin analogs

Figures & data

Table 1 Demographic characteristics

Characteristic	BAK-free travoprost	Bimatoprost	Latanoprost
N	203	747	1651
Age, mean ± SD*	62.1 ± 10.7	65.1 ± 10.7	64.1 ± 11.5
Gender, % female	50.7%	49.4%	53.4%

* Note: P = 0.0096 across treatment groups.

Abbreviations: BAK, benzalkonium chloride; SD, standard deviation.

Table 2 Unit costs

Resource	Description/Size	Cost*
Initial visit	CPT 92004 (comprehensive, new patient) plus weighted costs for visual field examination (CPT 92082), gonioscopy (CPT 92020), evaluation of optic disc (CPT 92135), optic nerve head photograph (CPT 92235), and fundus evaluation (CPT 92250) per Fremont et al^Citation17	$582.61^Citation20
Follow-up visit	CPT 92012 (intermediate, established patient) and visual acuity examination (CPT 99173) per Fremont et al^Citation17	$117.68^Citation20
Prostaglandin analog	2.5 mL	$81.60^Citation19
Fixed-combination dorzolamide 2.0%-timolol 0.5%	5 mL	$130.80^Citation19
Brimonidine 0.1%	5 mL	$62.80^Citation19
Brinzolamide 1.0%	10 mL	$91.38^Citation19
Timolol 0.25%	5 mL	$17.93^Citation19
Other	5 mL	$75.73 (assumption)

* Note: Costs are expressed in 2009 US$.

Figure 1 Patient selection.

Table 3 Treatment patterns and costs during observation period

Treatment pattern	BAK-free travoprost	Bimatoprost	Latanoprost
Number remaining on index therapy (n)	203	747	1651
Remained on monotherapy (%)**	65.0%	48.7%	62.8%
Required adjunctive therapy (%)**	35.0%	51.3%	37.3%
Median time to adding adjunctive therapy (days)	113	83	101
Mean time to adding adjunctive therapy (days); mean ± SD (interquartile range)**	221 ± 223 (56–397)	140 ± 156 (34–175)	181 ± 187 (41–263)
Type of adjunctive therapy
α2-adrenergic receptor agonist (%)	19.7%	26.1%	24.6%
Beta-blocker (%)	35.2%	24.5%	34.1%
Carbonic anhydrase inhibitor (%)	7.0%	7.0%	5.4%
Fixed-combination beta-blocker- carbonic anhydrase-inhibitor (%)	28.2%	35.2%	29.4%
Other adjunctive therapy (%)	9.9%	7.0%	6.5%
Number of prescriptions of index prostaglandin	10.7 ± 6.2	13.5 ± 7.6	13.6 ± 9.5
Total costs, 24 months	$2556.87	$3147.40	$2842.60

** Note: P < 0.0001 across treatment groups.

Abbreviations: BAK, benzalkonium chloride; SD, standard deviation.

Table 4 Rate of surgical procedures during observation period (number per patient)

Procedure	CPT	BAK-free travoprost	Bimatoprost	Latanoprost
Laser trabeculoplasty1	68566	0.000	0.000	0.000
Trabeculectomy, no previous surgery2	66170	0.005	0.024	0.010
Trabeculectomy, previous surgery or trauma2	66172	0.015	0.007	0.004
Aqueous shunt to reservoir2	66180	0.034	0.013	0.010
Revision of aqueous shunt3	66185	0.000	0.003	0.002
Iridectomy, peripheral, for glaucoma3	66625	0.000	0.000	0.000
Iridectomy, sector, for glaucoma1	66630	0.000	0.000	0.000
Cyclophotocoagulation, transscleral2	66710*	0.005	0.003	0.006
Cyclophotocoagulation, endoscopic4	66711	0.000	0.007	0.001
Laser iridotomy2	66761	0.015	0.033	0.036
Laser iridoplasty1	66762	0.000	0.003	0.005
Total		0.074	0.093	0.078

* Notes: In 2006, this included 66711;

1 none performed;

2 not significantly different across treatment groups;

3 no significant difference between bimatoprost and latanoprost; comparison with BAK-free travoprost could not be performed due to sample size;

4 rate significantly lower for latanoprost than bimatoprost, BAK-free travoprost rate similar to bimatoprost.

Abbreviations: BAK, benzalkonium chloride, CPT, Current Procedural Terminology.

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