A PHARMACOECONOMIC ANALYSIS OF RIMEXOLONE FOR THE TREATMENT OF OPHTHALMIC INFLAMMATORY CONDITIONS

Topical steroids are the standard first-line therapy for treating opht halmic inflammatory conditions. However, potent ophthalmic steroids ca n lead to an elevation of intraocular pressure (IOP), which can result in greater medical resource utilization and increased costs. We have developed a decision analysis model from a societal perspective to eva luate the costs and consequences of the treatment of ophthalmic inflam matory conditions with two potent topical steroids: prednisolone and r imexolone. Data for the model are based on information from clinical t rials, national databases, published literature, and responses by opht halmologists to a questionnaire on treatment patterns for elevated IOP . Three steroid-responsive conditions are examined separately with the model: uveitis; postoperative inflammation following cataract surgery ; and other ophthalmic inflammatory conditions (blepharitis, episcleri tis, postoperative refractive surgery, and corneal transplant). The mo del evaluates patients with acute conditions versus those with chronic conditions and those with mild to moderate elevation of IOP versus th ose with severe elevation of IOP. Although the unit cost of rimexolone is higher than that of prednisolone, use of rimexolone leads to cost savings because the incidence of elevated IOP is decreased. If rimexol one is used instead of prednisolone for the treatment of ophthalmic in flammatory conditions, the estimated cost saved (at 1995 AWP prices) i s approximately $10 million across the entire US population. The savin gs across the health maintenance organization population on an annuali zed basis is approximately $3.9 million. Even if rimexolone were price d higher than current market charges (at 130% to 150% of the AWP of pr ednisolone), cost savings ranging from $2.9 million to $720,000 would accrue with use of rimexolone compared with prednisolone. However, if rimexolone were priced at 160% of the AWP of prednisolone, its use wou ld incur an additional cost of $300,000. The primary medical resource utilized in treating elevated IOP in ophthalmic inflammatory condition s is physician visits. Medications are responsible for only one-fifth to one-third of the total cost of treating elevated IOP. This analysis indicates that rimexolone is associated with decreased medical resour ce utilization and cost savings to the entire healthcare system.