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Current Knowledge and Attitudes Concerning Cost-Effectiveness in Glaucoma Pharmacotherapy: A Glaucoma Specialists Focus Group Study

Authors Feldman RM, Cioffi GA, Liebmann JM, Weinreb RN

Received 25 October 2019

Accepted for publication 9 January 2020

Published 6 March 2020 Volume 2020:14 Pages 729—739


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Robert M Feldman,1 George A Cioffi,2 Jeffrey M Liebmann,3 Robert N Weinreb4

1The University of Texas Medical School Houston, TX, USA; 2Department of Ophthalmology, NewYork Presbyterian Hospital Columbia University Irving Medical Center, NY, New York, USA; 3Columbia University Medical Center, New York, NY, USA; 4University of California San Diego, LaJolla, CA, USA

Correspondence: Robert M Feldman
Department of Ophthalmology and Visual Science, The University of Texas Medical School at Houston, 6400 Fannin St., Ste 1800, Houston, TX 77030, USA
Tel +1 713 559 5200
Fax +1 713 795 0733

Background: Rising healthcare costs motivate continued cost-reduction efforts. To help lower costs associated with open-angle glaucoma (OAG), a prevalent, progressive disease with substantial direct and indirect costs, clinicians need to understand the cost-effectiveness of intraocular pressure (IOP)-lowering pharmacotherapies. There is little published information on clinicians’ knowledge and attitudes about cost-effectiveness in glaucoma treatment.
Purpose: This pilot focus group study aimed to explore clinician attitudes and perspectives around the costs and cost drivers of glaucoma therapy; the implementation of cost-effectiveness decisions; the clinical utility of cost-effectiveness studies; and the cost-effectiveness of available treatments.
Methods: Six US glaucoma specialists participated in two separate teleconferencing sessions (three participants each), managed by an independent, skilled moderator (also a glaucoma specialist) using a discussion guide. Participants reviewed recent publications (n=25) on health economics outcomes research in glaucoma prior to the sessions.
Results: Participants demonstrated a clear understanding of the economic burden of glaucoma therapy and identified medications, diagnostics, office visits, and treatment changes as key cost drivers. They considered cost-effectiveness an appropriate component of treatment decision-making but identified the need for additional data to inform these decisions. Participants indicated that there were only a few recent studies on health economics outcomes in glaucoma which evaluate parameters important to patient care, such as quality of life and medication adherence, and that longitudinal data were scant. In addition to efficacy, participants felt patient adherence and side-effect profile should be included in economic evaluations of glaucoma pharmacotherapy. Recently approved medications were evaluated in this context.
Conclusion: Clinicians deem treatment decisions based on cost-effectiveness data as clinically appropriate. Newer IOP-lowering therapies with potentially greater efficacy and favorable side-effect and adherence profiles may help optimize cost-effectiveness. Future studies should include: clinicians’ perspectives; lack of commercial bias; analysis of long-term outcomes/costs; more comprehensive parameters; real-world (including quality-of-life) data; and a robust Markov model.

Keywords: open-angle glaucoma, ocular hypertension, cost-effectiveness, clinician knowledge and attitudes, focus group, prostaglandin analogs

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