Cost-effectiveness of latanoprost and timolol maleate for the treatment of glaucoma in Scandinavia and the United Kingdom, using a decision-analytic health economic model.

PURPOSE: To assess the cost-effectiveness of latanoprost or timolol in glaucoma treatment in Norway, Sweden, Denmark (Scandinavia) and the United Kingdom (UK). METHODS: A Markov model was constructed to perform a cost-effectiveness analysis. Health states were 'stable' and 'progressed' glaucoma, and transition probabilities for both primary open-angle and exfoliation glaucoma were derived from the medical literature. Practice patterns were obtained from surveys completed by 54 ophthalmologists geographically dispersed throughout each country. Country specific unit costs were used for medications, patient visits, diagnostics, and therapeutic procedures. RESULTS: Over the life of the model latanoprost was less expensive than timolol by 5.3-7.6% (Scandinavia) and 2.1% (UK). Following adjustments, therapy in the original timolol-treated cohort was slightly more effective in each country with a difference in 0.003-0.015 years to progression of glaucoma existing between latanoprost. This may have resulted from the model design, which reflected that physicians ultimately control most patients' glaucoma over 5 years by adding or changing therapy. The associated incremental cost-effectiveness ratios for latanoprost vs timolol generated by the Scandinavian and the UK models, respectively, were: Norway 351,396 NOK; Sweden 988,985 SEK; Denmark 351,641; and the UK 4751 GBP. CONCLUSIONS: Over 5 years, in the UK timolol is the cost-effective option, whereas in Scandinavia latanoprost may be the cost-effective alternative to timolol.

An assessment of readiness for behaviour change in patients prescribed ocular hypotensive therapy.

OBJECTIVES: To compare responses in two patient populations with a questionnaire developed to identify those prescribed ocular hypotensive medication whose adherence may need improvement and who may be ready to change. METHODS: The content/face validity of a 62-item, self-administered questionnaire was confirmed by nine glaucoma specialists. Questions concerned demographics, health and medications, use of/problems with medications, and visual function. The questionnaire was administered anonymously to 102 consecutive patients in a glaucoma referral practice ('glaucoma practice') and 100 from a multispecialty ophthalmology practice ('multispecialty practice'). All participants were prescribed >or=1 ocular hypotensive medication and had no previous trabeculectomy. RESULTS: Patients in the glaucoma practice were more likely to be younger, African-American, and better educated (P<0.05 for each). In both, >80% had glaucoma with >60% diagnosed >or=3 years previously. Most (glaucoma, multispecialty: 87, 93%) reported administering drops every day, but more in the multispecialty practice reported administering drops at the same time every day (79, 92%; P<0.05). Number of adherence problems (mean, 1/patient) and adherence scores (mean, 24; possible scale range, 0-25) were similar. Common adherence barriers were falling asleep and forgetting when the regular schedule changed or when travelling. In the glaucoma practice, the number of adherence problems was correlated with adherence score (r=-0.611; P<0.0001) and number of side effects (r=0.349; P<0.0001). CONCLUSIONS: Similarities between patient populations limited our ability to compare responses between groups or to propose adherence counselling tailored to specific demographics. Until such recommendations are possible, physicians should incorporate adherence counselling broadly into their practices.