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

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

Patient-reported benefit of ReSTOR® multi-focal intraocular lenses after cataract surgery: Results of Principal Component Analysis on clinical trial data

<p>Abstract</p> <p>Background</p> <p>Restoration of functional distance and near vision independently of additional correction remains a goal for cataract surgery. ReSTOR^®, a new multi-focal intraocular lens (IOL) addresses this issue with an improvement in both distance and near vision, often without need for glasses. This analysis attempted to discuss the patient-reported benefit of ReSTOR^®using a full but organised representation of data.</p> <p>Methods</p> <p>Two non-randomised, open-label clinical trials conducted in Europe and the United-States were conducted to compare the efficacy of ReSTOR^®to AcrySof^®mono-focal IOLs. A total of 710 patients in need of bilateral cataract extraction were included in the pooled study. The TyPE, a patient questionnaire, was fully completed by 672 of them before and after each eye surgery. The TyPE, composed of 67 items measuring overall visual functioning in both conditions (with and without wearing glasses), evaluates limitations, troubles and satisfaction in distance and near vision. A principal component analysis (PCA) of the TyPE questionnaire was performed on pooled data from baseline and post-surgery observations in order to fully represent the change in the TyPE data over time. ReSTOR^®and mono-focal groups were used as illustrative variables. The coordinates of the first 2 factors were compared between visits and between IOLs (ReSTOR^®vs. mono-focal), using paired t-tests and t-tests, respectively.</p> <p>Results</p> <p>The first factor of the PCA explained 55% of the variance and represented 'visual functioning and patient satisfaction'. The second factor explained 6% of the variance and was interpreted as 'independence from glasses'. An overall difference in factorial coordinates in both factors was seen between baseline and the first eye surgery, and between the first and the second eye surgery. No difference between ReSTOR^®and mono-focal IOL groups was observed at baseline. After surgery, ReSTOR^®treated-patients had higher coordinates on both "visual functioning and satisfaction" and "independence from glasses" factors. Findings observed on the factorial plan were supported by statistical comparisons of factorial coordinates.</p> <p>Conclusion</p> <p>Both mono-focal and ReSTOR^®-implanted patients improved their visual functioning after bilateral cataract surgery. Moreover, ReSTOR^®patients reported an additional benefit in independence from glasses as well as in visual functioning and patient satisfaction.</p

Five-year extension of a clinical trial comparing the EX-PRESS glaucoma filtration device and trabeculectomy in primary open-angle glaucoma

This study compared the efficacy of the EX-PRESS(®) glaucoma filtration device and trabeculectomy in primary open-angle glaucoma up to five years after surgery. Patients from a previously reported randomized, open-label, parallel-arm clinical trial in which 78 patients received either the EX-PRESS glaucoma filtration device or underwent a trabeculectomy were followed for up to an additional four years (five total) beyond the original study (39 eyes per treatment group). Risk-benefit data were obtained for up to five years after glaucoma surgery. Outcome variables were intraocular pressures and intraocular pressure medications. Complete success was denoted by intraocular pressure values ≤ 18 mmHg without medication. The EX-PRESS glaucoma filtration device controlled intraocular pressure more effectively without medication for more patients from year 1 (86.8% versus 61.5%, P = 0.01) to year 3 (66.7% versus 41.0%, P = 0.02) than trabeculectomy. At year 1, only 12.8% of patients required intraocular pressure medication after EX-PRESS implantation, compared with 35.9% after trabeculectomy. The proportions became closer at year 5 (41% versus 53.9%). The responder rate was higher with EX-PRESS and time to failure was longer. In addition, surgical interventions for complications were fewer after EX-PRESS implantation. This five-year analysis confirmed and extended the results reported after one year. Compared with trabeculectomy, EX-PRESS provided better intraocular pressure control in the first three years, and patients required fewer intraocular pressure medications and fewer surgical interventions during the five-year study period. For patients with primary open-angle glaucoma, the EX-PRESS glaucoma filtration device, implanted under a superficial scleral flap, produced significantly higher success rates than trabeculectomy. EX-PRESS is an effective device for long-term treatment of primary open-angle glaucom

Cost of cataract surgery after implantation of three intraocular lenses

Catherine Boureau1, Antoine Lafuma2, Viviane Jeanbat2, Andrew F Smith3, Gilles Berdeaux41Clinique Geoffroy St Hilaire, Paris, France; 2Cemka-Eval, Bourg la Reine, France; 3Alcon Laboratories Ltd, Hemel Hempstead, UK and Nuffield Laboratory of Ophthalmology, University of Oxford, UK; 4Alcon France, Rueil Malmaison, France; Conservatoire National des Arts et M&amp;eacute;tiers, Paris, FranceBackground: Posterior capsule opacification is one of the most frequent adverse events following cataract surgery. This manuscript reports the lifetime cost of complications linked to posterior capsule opacification using three types of intraocular lens with square edges.Methods: Costs were estimated from a retrospective study of patients who underwent cataract surgery and data from the literature. The lenses studied were hydrophobic acrylic (SA60AT and AR40E) and hydrophilic acrylic (XL-Stabi) lenses with square edges. The frequency of Nd-Yag laser capsulotomies after 4 years&amp;rsquo; survival was estimated by two methods: the first involved linear adjustment of the rate at 5 and 6 years follow-up and then application of a constant rate after 6 years; the second involved linear adjustment after 5 years follow-up. The economic perspective was that of the French Sickness Fund.Results: After 3 years&amp;rsquo; follow-up the percentage of patients who had not undergone laser Nd-Yag capsulotomy was 86.9% with SA60AT, 76.6% with AR40E and 54.6% with XL-Stabi lenses (p &amp;lt;&amp;nbsp;0.001). The total cost of capsulotomy and management of complications per patient lifetime was estimated to be &amp;euro;90.5 for SA60AT, &amp;euro;189.5 for AR40E and &amp;euro;288.0 for XL-Stabi lenses by the first extrapolation method. With the second method of extrapolation the costs were &amp;euro;94.8, &amp;euro;200.0 and &amp;euro;300.2, respectively.Interpretation: Lower costs for cataract surgery and management of related complications were observed with the two hydrophobic acrylic lenses; the lowest costs were observed with SA60AT lenses as they were associated with fewer Nd-Yag laser capsulotomies.Keywords: cataract surgery, Nd-Yag laser, capsulotomy, adverse event, cost, budget impac

Prevalence and burden of self-reported blindness and low vision for individuals living in institutions: a nationwide survey

BACKGROUND: The prevalence of self-reported low vision (LV) and blindness, and their associated disabilities, handicaps and socio-economic consequences for individuals living in institutions are poorly documented. METHODS: 2,075 institutions were selected at random and eight individuals were picked at random from the list of residents. Three groups of individuals were defined: blind, LV, and a control group (CG). These were compared after adjustment for age and co-morbidities. Of the 15,403 individuals, 14,603 interviews (94.9%) were completed. RESULTS: The prevalence of blindness was 1.6% and the LV 13.4%. Blind individuals needed assistance more often (OR: 2.65 to 11.35) than CG members while the assistance required by LV individuals was similar to that for the CG. Blind individuals required institution adaptation (building and furniture changes) more often than the CG. Blind (57.9%) and LV individuals (35.4%) were more often registered for social allowances. Monthly social allowances were EUR 86 higher for blind than LV individuals. Monthly family incomes were found to be similar between the three groups (from EUR 782 to 797). Social and demographic data, institution description, income, handicaps, disabilities, social allowances and details of daily activities were collected interviews CONCLUSION: The results demonstrate the impact of self-reported blindness and LV on daily life for patients living in institutions

Daily costs of prostaglandin analogues as monotherapy or in fixed combinations with timolol, in Denmark, Finland, Germany and Sweden

BACKGROUND: To compare the daily costs of 3 prostaglandin analogues (bimatoprost, latanoprost, travoprost), alone, and associated with timolol in 4 European countries (Denmark, Finland, Germany, and Sweden). METHODS: Six glaucoma products were sampled by buying 5 bottles from 1 suburban pharmacy in each of the 4 countries. Drops were weighed by a single operator at 1 site according to standardized procedures. Residual drops were then counted. Unit bottle costs were estimated from tariff lists. Eye-drop weights were entered into a nested analysis of variance comprising drug, instillation day, country, the interaction, and a sample factor nested within the country factor. Effectiveness was represented by treatment failure rates estimated from a meta-analysis and a general practitioner survey. RESULTS: Every drug bottle contained sufficient drops to treat 1 patient for 28/31 days. Drop-size heterogeneity between countries was observed for bimatoprost and bimatoprost/timolol. Mean travoprost and travoprost/timolol drop-sizes were the smallest, and drop-counts per bottle were the lowest for latanoprost, or latanoprost/timolol. In all 4 countries annual costs were least for travoprost and travoprost/timolol. CONCLUSIONS: On taking into account drug costs and effectiveness, travoprost and travoprost/timolol were cheaper and more effective than latanoprost and latanoprost/timolol and were cheaper than bimatoprost and bimatoprost/timolol