Purchase this article with an account.
RG Fiscella, MA Alexander, JG Walt; Patient Reported Outcomes of Nedocromil Ophthalmic Solution And Oral Fexofenadine . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3073.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: Patients with seasonal allergic rhinoconjunctivitis (SAC) often receive 2nd generation oral antihistamines and/or topical antiallergy medication for their symptoms. We reviewed 3 treatment regimens and determined the cost consequences of each. Methods: We analyzed data from a randomized, single-masked, 2 study site, 1 month clinical trial performed by one of us (MA). Patients (N=89) were assigned either 1) nedocromil sodium (NS) 2% eyedrops (Alocril) bid with fexofenadine (FF) 60 mg capsules (Allegra) up to bid as escape medication; 2) FF bid with NS (up to bid) as escape med; or 3) NS bid plus FF qd (no escape med). All patients could use levocabastine (LC) nasal spray PRN. Signs and symptoms of SAC were assessed weekly, as was patient reported outcomes of quality of life (QoL) using the RQLQ(S) questionnaire and willingness to use the regimen again. Actual daily medication usage was recorded. We then determined the relative actual cost of the 3 regimens using cost minimization methods. Results: Scores for symptom severity, clinical signs, and QoL improved from baseline in all groups. Patients and physicians judged the 2 regimens containing NS bid to be more effective in moderate to full overall control than FF bid with NS rescue. Significantly more patients receiving NS bid would continue treatment compared to those taking FF bid with NS rescue (P < .03). Escape medication use for NS bid patients was 0.64 capsule/day, while escape use of NS for the FF bid group was 0.37 uses/day. Among those using NS bid, daily average use of 0.64 capsule of FF (half the labeled dose) effectively controlled symptoms. LC use did not differ among groups. Using current average wholesale prices and the actual usage, the expected monthly cost of allergy medication (including escape medication) for the 2 regimens containing nedocromil bid would be 37% less (for NS with FF rescue) and 27% less (for NS with FF qd) than FF bid with NS rescue. Conclusion: Given the increasing costs of health care and the concern for patient reported outcomes and QoL, physicians must balance benefits of available treatments with outcomes, patient satisfaction, and cost alternatives. In this case, since the 3 regimens provided equivalent symptomatic relief, cost is a consideration. The most effective and efficient treatment for SAC patients with the highest level of patient satisfaction would be a prescription for nedocromil drops bid with 20 fexofenadine capsules taken PRN, with refill options on both. This regimen provides maximum effectiveness and patient outcomes while minimizing usage of systemic medication.
This PDF is available to Subscribers Only