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P. M. Buchholz, A. B. Hommer, J. Wickstrøm, J. Walt; Cost-Effectiveness Analysis of the Fixed Combinations Brimonidine/Timolol and Dorzolamide/Timolol in 12 Countries. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4982.
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To compare the efficacy and cost-effectiveness of the fixed combination glaucoma medications brimonidine 0.2%/timolol 0.5% (Combigan®) versus dorzolamide 2%/timolol 0.5% (Cosopt®) in 12 countries.
Efficacy and safety of the 2 fixed combinations were based on pooled data from 2 head-to-head trials. Efficacy was measured as the percentage of patients reaching a predefined target IOP level ≤18 mmHg or ≤13 mmHg after 3 months of treatment. Discontinuation rates due to adverse events were included in the model, and it was assumed that patients discontinuing treatment had an extra ophthalmologist visit. All drug costs were market prices inclusive of VAT and ophthalmologist visit costs were priced using official tariffs.
Data on clinical efficacy showed that Combigan® was more effective than Cosopt® in terms of lowering patients’ IOP to a target level: the percentage of patients reaching IOP ≤13 mmHg was 32.65% for Combigan® and 13.95% for Cosopt® (p = .0359), 77.55% of Combigan® patients reached a target IOP ≤18 mmHg, and 60.47% of Cosopt® patients did (p = .0756). Three months’ health care costs for patients treated with Combigan® were comparable to costs of Cosopt® in the 12 studied countries.
Combigan® was less costly and more effective in Italy, Spain, Canada and Norway, whereas Combigan® was more effective and slightly more costly in Germany, the United Kingdom, Denmark, Sweden, the Netherlands, Portugal, France and the United States. In these countries, the incremental cost per patient reaching a target IOP level ≤18 mmHg was $0.66 to $96; for IOP ≤13 mm Hg the range was $0.60 to $87.83. Hence, Combigan® is effective in terms of lowering IOP and is a cost-effective treatment strategy for patients with glaucoma.
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