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F. Honrubia, N. Neymark, P. Buchholz, X. Badia, G. Kobelt; A Retrospective Observational Study of Resource Utilization and Costs Associated With Combination Therapy of Glaucoma Patients in Spain Over 2 Years. Invest. Ophthalmol. Vis. Sci. 2007;48(13):2402.
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To determine the direct medical costs of managing glaucoma patients using first- or second-line combination therapy over a period of 24 months. Patients initiating a combination therapy containing an alpha-agonist were compared with patients treated with any other type of combination therapy.
Retrospective review of patient charts for 216 patients from 21 Spanish centers starting combination therapy in 2002/3. The follow-up period was 24 months, and costs were determined by multiplying the recorded resource use per patient with Spanish unit cost figures obtained from public sources.
Patients initiating therapy with an alpha-agonist (N = 42) were similar with respect to age and baseline IOP to patients started on any other combination therapy (N = 174). There were no statistically significant differences between the two groups with respect to treatment failure in terms of changing drug combination at least once (42% of all patients) or not achieving an IOP ≤ 17 mm Hg at the end of the period (50% overall). The proportion of patients needing surgery, 13% overall, was also similar in the two groups. The mean direct medical costs over 2 years per patient were 1212 € in the alpha-agonist group and 1152 € in the group initiated on any of the other combinations observed. A multiple regression analysis showed that the statistically significant determinants of mean total direct medical costs were the patient’s age, the costs of procedures performed during control visits, surgical interventions and the fact of changing drug combination at least once. Baseline IOP and the type of combination drug therapy used initially had no impact on average total costs, when controlling for the other factors. Within the alpha-agonist group, a combination with a beta-blocker lead to significantly lower costs than for other combinations (predominantly with a prostaglandin analog), 915 € versus 1346 €. End IOP was similar (18.6 vs 18.4 mmHg) and the number of treatment changes was similar (46% versus 48% respectively). Slightly fewer patients achieved target IOP, however the sample was too small to assess whether this difference was significant.
Initiating combination drug therapy with an alpha-agonist containing regimen results in costs and outcomes similar to those obtained starting with other combinations.
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