Prostaglandin Analogues for Ophthalmic Use: Analysis of Clinical and Cost-Effectiveness

Technology and Condition
Prostaglandin analogues (PGAs) in the treatment of elevated intraocular pressure (IOP): bimatoprost, latanoprost, and travoprost

Issue
PGAs are more costly than alternative agents for the lowering of IOP. One policy decision to be made is whether reimbursement of these agents as first-line therapy with no restrictions represents an optimal use of limited resources.

Methods and Results
A systematic review of the clinical literature was conducted. Twenty-two RCTs comparing PGAs to alternative therapy in individuals >18 years old with elevated IOP who were treatment-naïve or who experienced appropriate washout before treatment were included. A cost-effectiveness analysis was conducted from the perspective of Canadian ministries of health. A decision-analytic model using a three-month time horizon calculated the associated costs and consequences of using latanoprost versus timolol, dorzolamide, and brimonidine; and travoprost versus timolol.

Implications for Decision Making

  • Not all PGAs are the same. There is evidence that latanoprost and travoprost reduce IOP more effectively than timolol. The same evidence does not exist for bimatoprost.
  • Timolol that is used as a first-line option could represent an optimal use of scarce resources. For appropriate patients, it would be preferable, from a cost-effectiveness standpoint, to start treatment with timolol and reserve the PGAs as an alternative treatment or as add-on therapy for patients not achieving a clinical response with timolol.
  • PGAs may be cost-saving, depending on the alternative. Compared to dorzolamide, latanoprost is more effective and less costly. Compared to brimonidine, latanoprost is associated with additional costs, at a lower cost per mm Hg reduced.
  • The long-term benefit from PGAs is unclear. There is no evidence that greater reductions in IOP translate into reductions in visits to a physician or surgical procedures, or an increase in health-related quality of life.

This summary is based on a comprehensive health technology assessment available from CADTH’s web site (www.cadth.ca): Hodge WG, Lachaine J, Steffensen I, Murray C, Barnes D, Foerster V, Ducruet T, Mensinkai S. Prostaglandin analogues for ophthalmic use: analysis of clinical and cost-effectiveness.