Mt. Halpern et al., A PHARMACOECONOMIC ANALYSIS OF RIMEXOLONE FOR THE TREATMENT OF OPHTHALMIC INFLAMMATORY CONDITIONS, American journal of managed care, 4(6), 1998, pp. 854-862
Citations number
11
Categorie Soggetti
Heath Policy & Services","Medicine, General & Internal
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.