Demonstration of an online tool to assist managed care formulary evidence-based decision making: meta-analysis of topical prostaglandin analog efficacy

Abstract

Steven M Kymes1, Caroline Burk2, Todd Feinman3, Julia M Williams4, David A Hollander41Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, MO, USA; 2Health Outcomes, Allergan Inc, Irvine, CA, USA; 3Doctor Evidence LLC, Santa Monica, CA, USA; 4Global Medical Affairs, Allergan Inc, Irvine, CA, USABackground: The purpose of this paper was to demonstrate the use of an online service for conducting a systematic review and meta-analysis of the efficacy of topical prostaglandin analogs in reducing intraocular pressure (IOP) in glaucoma and ocular hypertension.Methods: An online service provider (Doctor Evidence) reviewed and extracted data from the peer-reviewed literature through September 2009. Randomized controlled studies of at least three months' duration assessing at least two prostaglandin analogs in patients with primary open-angle glaucoma, ocular hypertension, or normal-tension glaucoma were included. The primary endpoint was mean IOP. Summary estimates were created using random-effects models. The Q Chi-square test was used to assess statistical heterogeneity.Results: Sixteen studies satisfied the inclusion criteria and were analyzed. On average, greater IOP-lowering was seen with bimatoprost relative to latanoprost (1 mmHg, P = 0.025) and travoprost (0.8 mmHg, P = 0.033) based on mean IOP after 12–26 weeks of treatment. No statistical difference was observed in IOP-lowering between latanoprost and travoprost (P = 0.841). Findings were similar to previously published meta-analyses of topical prostaglandin analogs.Conclusion: Systematic reviews relying on meta-analytic techniques to create summary statistics are considered to be the "gold standard" for synthesizing evidence to support clinical decision-making. However, the process is time-consuming, labor-intensive, and outside the capability of most formulary managers. We have demonstrated the effectiveness of a commercial service that facilitates the process of conducting such reviews.Keywords: evidence-based medicine, meta-analysis, review, systematic, prostaglandin analogs, glaucoma