Costs and persistence of alpha-2 adrenergic agonists versus carbonic anhydrase inhibitors, both associated with prostaglandin analogues, for glaucoma as recorded by The United Kingdom General Practitioner Research Database

Abstract

Philippe Denis1, Antoine Lafuma2, Gilles Berdeaux31Hôpital Edouard Herriot, Lyon, France; 2Cemka, Bourg-la-Reine, France; 3Alcon France, Rueil-Malmaison, FranceAbstract: The persistence and costs of carbonic anhydrase inhibitors + prostaglandin analogues (CAIs + PGAs) vs alpha-2 adrenergic agonists + prostaglandin analogues (alpha-2 agonists + PGAs) were compared, based on The United Kingdom General Practitioner Research Database. Patients with a diagnosis of ocular hypertension, glaucoma, or treated for this, were selected. Selected patients were prescribed CAIs + PGAs or alpha-2 agonists + PGAs. Treatment failure was defined as a prescription change (adding, removing, or replacing glaucoma treatment, or initiating laser or surgery). Times to treatment failure were compared with a Cox model adjusted by a propensity score. Mean patient age was 69.0 years and 47.6% were males. Treatment failure at 1 year was experienced by 58.8% receiving CAIs + PGAs and 66.0% of patients receiving alpha-2 agonists + PGAs (p < 0.001). The hazard ratio for failure was 0.82 (p < 0.001) in favor of CAIs + PGAs after adjusting on age, gender, comorbidities, and duration of follow-up. Adjusted annual costs of glaucoma management did not differ significantly between treatments, £440.63 with alpha-2 agonists + PGAs and £413.37 with CAIs + PGAs. CAIs + PGAs therapies appear more persistent than alpha-2 agonist + PGA in everyday clinical practice, at a similar cost.Keywords: glaucoma, alpha-2 adrenergic agonists, carbonic anhydrase inhibitor, prostaglandin, effectiveness economics, costs