Treatment persistence and cost-effectiveness of latanoprost/latanoprost–timolol, bimatoprost/bimatoprost–timolol, and travoprost/travoprost–timolol in glaucoma: an analysis based on the United Kingdom general practitioner research database

Antoine Lafuma¹, John F Salmon², Julien Robert¹, Gilles Berdeaux^3
1Cemka, Bourg-la-Reine, France; ²Oxford Eye Hospital, Oxford, UK; ³Conservatoire National des Arts et Métiers, Chaire Economie et Gestion des Services de Santé, Paris, France

Objective: To compare treatment persistence and costs with 3 glaucoma treatment sequences (first-line/second-line): latanoprost/latanoprost–timolol (LLT), bimatoprost/bimatoprost–timolol (BBT), and travoprost/travoprost–timolol (TTT), derived from the UK General Practitioner Research Database (UK-GPRD).
Methods: Patient records referring to ocular hypertension, topical glaucoma treatment, surgery, or laser therapy were extracted. Patients prescribed LLT, BBT, or TTT sequences were selected. Treatment failure was inferred from glaucoma prescription change (adding or removing a topical treatment, surgery, or laser therapy). Treatment durations preceding failure were compared by applying Wilcoxon’s test to survival curves. Adjustment on confounding variables was performed with a Cox model and a propensity score method. Unit costs were estimated from a UK National Health Service perspective.
Results: A total of 1592 patients received LLT, 110 BBT, and 114 TTT. Their mean age was 68 years and the sex ratio almost 1 male:1 female. No significant demographic or comorbidity differences were observed between treatment sequences. Treatment persistence at 36 months was achieved in 60.0% of LLT, 55.5% of BBT, and 70.3% of TTT patients (P = 0.005). Resources consumed and associated monthly costs were significantly less for the TTT group (£17.74) compared with BBT (£21.30) and LLT (£22.37) groups.
Conclusion: Analysis of data obtained from the UK-GPRD suggests that the TTT treatment sequence achieved longer treatment persistence at lower cost than LLT and BBT.

Keywords: glaucoma, travoprost, timolol, latanoprost, bimatoprost, persistency, costs