Original article
Medical therapy cost considerations for glaucoma

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Abstract

Purpose

To determine the calculated daily patient cost (cost minimization) of medical glaucoma therapy and review cost trends.

Design

Experimental, controlled, prospective study.

Methods

The actual volume of various glaucoma medications or glaucoma medications with redesigned bottles was determined for most commercially available sizes of the tested products. The drops per milliliter based on the actual volume and the daily costs of the dosage schedules recommended by the manufacturers were compared. The cost of each bottle of medication was determined from the average wholesale price (AWP) in the United States. A comparison to 1999 prices where applicable will be analyzed to review costing trends.

Results

The generic timolol products (range, $0.38– $0.46 per day) were similar on a cost per day basis vs Betimol (Santen, Napa Valley, California, USA), Optipranolol (Bausch and Lomb Pharmaceuticals, Tampa, Florida, USA) and Timoptic (Merck, West Point, Pennsylvania, USA). Their percentage cost increase ranged from 5% to 22% since 1999, except for generic timolol XE gel-forming solution (48%). Betagan (Allergan, Irvine, California, USA), Betoptic S (Alcon Laboratories, Fort Worth, Texas, USA), and Ocupress (Novartis, Duluth, Georgia, USA) ranged from $0.88 to $1.11 per day, and their percentage cost increase ranged from 33% to 53%. Some brand-only products have raised their AWPs a greater percentage, including Betoptic S (37%), Iopidine (Alcon, Fort Worth, Texas, USA) (50%), Ocupress (Novartis Ophthalmics, Duluth, Georgia, USA) (53%), and Pilopine gel (Alcon, Fort Worth, Texas, USA) (32%).The mean cost per day for the topical carbonic anhydrase inhibitors Azopt (Alcon Laboratories; $1.33 per day) and Trusopt (Merck; $1.05 per day) differed from 1999 when prices were almost identical. Cosopt (Merck; timolol 0.5% plus dorzolamide 2%, $1.04 per day) was less than the cost of separate bottles of a topical carbonic anhydrase inhibitor and a β-blocker.The selective α-2 agonist brimonidine 0.15% with Purite (Alphagan-P, Allergan, 5 ml) twice daily was $1.29 per day. The prostaglandin analogs were comparably priced with Lumigan (Allergan) $0.95 per day, Xalatan (Pharmacia and Upjohn, Kalamazoo, Michigan, USA) $1.25 per day, Travatan (Alcon Laboratories) $1.01 per day, and Rescula (Novartis) $0.90 per day.

Conclusions

All generic timolol, Betimol, Optipranolol, Timoptic, and Timoptic XE (Merck) ranged from $0.38 to $0.50 per day. Other β-blocker products were about twice as costly, ranging from $0.88 to $1.11 per day. Cosopt ($1.05 per day) was less costly than separate bottles of a topical β-blocker and a topical carbonic anhydrase inhibitor dosed three times daily or twice daily. The prostaglandin analogs ranged from $0.90 per day (Rescula) to $1.25 per day (Xalatan). Newer glaucoma medications exhibit similar costs per day in many cases, compared with more traditional medications, especially with greater price increases in older brand-only products.

Section snippets

Methods

All medications were ordered from a wholesaler and not from the manufacturer. The medication national drug codes (NDC number) and each lot number were recorded. The actual, not labeled, volume was determined for each bottle at 25 C. The bottles were held at approximately 135 degrees as the drops were collected, as described previously.3 After the drops ceased to flow, the bottle was inverted to 180 degrees to try to obtain every last complete drop. The entire content of each 2.5-ml bottle was

Results

Most products achieved the minimal volume on the label (that is, 5 ml, 10 ml, and so forth). Overfill needs to be considered when determining baseline costs, because some products contain less volume and some contain more volume than the stated label amount on each bottle.

The average number of drops per milliliter varied widely from 19.7 drops per milliliter (levobunolol) to 39.3 drops per milliliter for Rescula (Novartis; Table 1). The newer medications were more efficient in regard to number

Discussion

We had previously reported on the glaucoma medications on a cost per day basis.3 The number of drops per milliliter, the actual volume, and the cost per bottle are helpful in determining the daily treatment costs for patients with glaucoma. Using a general average (that is, 20 drops per milliliter) to estimate the number of drops per milliliter of a given ophthalmic medication is not accurate. This variability in overfill and drops per milliliter has been demonstrated by others.4, 5, 6, 7 Two

References (14)

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