First-year treatment costs among new initiators of topical prostaglandin analogs

Figures & data

Table 1 Unit costs

Resource	Description/Size	Cost
Initial visit	CPT 92004 (comprehensive, new patient) plus weighted costs for visual field exam (92082), gonioscopy (92020), evaluation of optic disc (92135), optic nerve head photograph (92235), and fundus evaluation (92250) per Fremont and colleagues^Citation19	$395.70^Citation14
Follow-up visit	CPT 92012 (intermediate, established patient), visual acuity exam (99173) per Fremont and colleagues^Citation19	$72.87^Citation14
Prostaglandin analog	2.5 ml	$75.07^Citation13
Fixed combination dorzolamide 2.0%/timolol 0.5%	5 ml	$67.41^Citation13
Brimonidine 0.1%	5 ml	$54.34^Citation13
Dorzolamide 2%	10 ml	$67.41^Citation13
Timolol 0.25%	5 ml	$17.93^Citation13
Other	5 ml	$52.37 (assumption)

Table 5 Sensitivity analyses during the follow-up period

Parameter changed Value to which it was changed	BAK-free travoprost	Travoprost	Bimatoprost	Latanoprost
Base case	$1,307	$1,278	$1,457	$1,359
Patients on monotherapy (%)
Decreased to 79.3% for all	$1,359	$1,309	$1,457*	$1,383
Increased to 91.1% for all	$1,307*	$1,255	$1,392	$1,317
Days to adjunctive therapy
Mean days to adjunctive therapy	$1,307*	$1,277	$1,442	$1,350
Decreased to 67.0 days for all	$1,318	$1,288	$1,457	$1,359*
Increased to 158.5 days for all	$1,307	$1,272	$1,431	$1,339
Cost of therapies
Changed to least expensive adjunctive (beta-blocker)	$1,290	$1,252	$1,403	$1,317
Changed to most expensive adjunctive (fixed combination)	$1,317	$1,299	$1,490	$1,391
Rounded up index therapy bottles	$1,329	$1,278*	$1,479	$1,382
Same number of index bottles across cohorts (9.0)	$1,329	$1,353	$1,404	$1,382
Rounded up adjunctive bottles	$1,309	$1,281	$1,463	$1,364
Cost of visits – alternative practice patterns
Based on Quigley and colleagues^Citation20	$1,187	$1,158	$1,337	$1,239
Based on American Academy of Ophthalmology
Minimum	$1,441	$1,413	$1,591	$1,494
Maximum^Citation18	$2,647	$2,619	$2,797	$2,700

Note:

* No change from base case.

Figure 1 Patient selection.

Table 2 Demographic characteristics

Characteristic	BAK-free travoprost	Travoprost	Bimatoprost	Latanoprost
N	1,150	1,046	1,792	5,075
Age, mean ± standard deviation	63.6 ± 13.5	64.6 ± 13.9	64.5 ± 14.1	63.8 ± 14.7
Gender, % female	57.4%	54.1%	54.2%	55.9%

Table 3 Treatment patterns during follow-up period

Treatment pattern	Index therapy
	BAK-free travoprost	Travoprost	Bimatoprost	Latanoprost
Number on index therapy (N)	404	316	735	2217
Remained on monotherapy (%)*	91.1%	86.1%	79.3%	83.5%
Required adjunctive therapy (%)	8.9%	13.9%	20.7%	16.5%
Median time to adding adjunctive therapy (days)**	158.5	123.0	69.5	67.0
Mean time to adding adjunctive therapy (days)	156.3	131.5	120.8	108.3
Type of adjunctive therapy:
α2-adrenergic receptor agonist (%)	30.5%	15.9%	22.4%	26.8%
Beta-blocker (%)	27.8%	38.6%	28.9%	35.6%
Carbonic anhydrase inhibitor (%)	16.7%	25.0%	17.1%	12.6%
Fixed-combination beta-blocker/carbonic anhydrase inhibitor (%)	16.7%	15.9%	25.7%	18.9%
Other adjunctive therapy (%)	8.3%	4.6%	5.9%	6.1%

Notes:

* P < 0.0001, chi-squared test;

** P < 0.05, Wilcoxon rank sum test.

Table 4 Resource use during follow-up period

Treatment pattern	Index therapy
	BAK-free travoprost	Travoprost	Bimatoprost	Latanoprost
Mean number of prostaglandin analog prescriptions (normalized to 2.5 ml)	8.7	8.0	9.7	8.7
Mean number of prescriptions for other glaucoma medications
α2-adrenergic receptor agonist (brimonidine 0.1%)	7.2	8.5	10.4	10.5
Beta-blocker (timolol 0.25%)	5.2	6.1	7.4	7.5
Fixed combination (dorzolamide 2.0%/timolol 0.5%)	5.7	6.7	8.2	8.3
Carbonic anhydrase inhibitor (dorzolamide 2%)	4.6	5.4	6.6	6.7
Other	6.4	7.5	9.2	9.3

Figure 2 Annual average cost per patient by category.

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