Berdeaux, G

Le pen, C

Maurel, F

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PEY10 COST-EFFECTIVENESS OF TWO TREATMENT SEQUENCES IN GLAUCOMA TREATMENT: XALATAN®-XALACOM® VERSUS TRAVATAN®-DUOTRAV® 

A368 Abstracts
PEY8
WHEN IS IT COST-EFFECTIVE TO TREAT OCULAR
HYPERTENSION? RESULTS OF A DECISION-ANALYTIC
HEALTH ECONOMIC MODEL
Stewart WC1, Stewart JA1, Nassar Q1, Mychaskiw MA2
1Pharmaceutical Research Network, LLC, Charleston, SC, USA, 2Pﬁzer
Inc, New York, NY, USA
OBJECTIVE: To assess the cost-effectiveness of treating ocular
hypertension (OHT) in the United States. METHODS: Cost-
effectiveness was estimated using a Markov model. Health states
were stable and progressed OHT. Data from the Ocular Hyper-
tension Treatment Study (OHTS) were used to derive practice
patterns and transition probabilities. Data were obtained from
Blue Cross/Blue Shield for speciﬁc unit costs for medications,
patient visits, diagnostics, and therapeutic procedures. A payer
perspective was adopted, the time horizon was 5 years, and costs
were discounted at 3% per year. RESULTS: Across all OHT
patients, the incremental cost-effectiveness ratio (ICER) was
$89,072 to prevent 1 case from progressing to primary open-
angle glaucoma. After adjusting for risk factors for progression
identiﬁed in multivariate analysis in the OHTS trial, minimally
cost-effective ICERs were: 20 years above the mean age of 56
years, ICER = $45,155; 4 mmHg above the mean intraocular
pressure of 25 mmHg, ICER = $46,748; 40 microns less than the
mean central corneal thickness of 573 microns, ICER = $36,683;
and 0.2 wider than the mean vertical cup/disc ratio of 0.4, ICER
= $35,633. CONCLUSIONS: This Markov model was based on
the results and practice patterns of the OHTS trial, and the
results suggest that treating all OHT patients may not be cost
effective. However, treating OHT patients with risk factors for
progression, i.e., advancing age, higher intraocular pressures,
thinner central corneal thicknesses, and wider vertical cup/disc
ratios, does appear to be cost-effective in preventing the onset of
glaucomatous damage.
PEY9
ASSESSMENT OF THE COST-EFFECTIVENESS OF
TRAVOPROST VERSUS LATANOPROST,AS SINGLE AGENTS
FOR GLAUCOMA TREATMENT IN FRANCE
Payet S1, Berdeaux G2, Launois R1
1REES, Paris, France, 2Alcon France, Rueil-Malmaison, France
OBJECTIVES: To assess the cost-effectiveness of travoprost
versus latanoprost as single agents to treat glaucoma in France.
METHODS: A Markov model reproduced the course, over 5
years, of patients beginning a prostaglandin as monotherapy
(PM). The effectiveness criterion was ‘mean time to treatment
change’ (MTTC), ﬁtted with a Weibull distribution from a
national survey. Possible switches were association (A), treat-
ment substitution (TS) and laser treatment or surgery (LS). After
LS, patients could remain without treatment or proceed to PM
or TS. Stratiﬁcation used intra-ocular pressure (IOP) at treatment
onset: ≤20 mmHg, 21 to 23 mmHg and ≥24 mmHg. Transition
probabilities and costs per treatment line were extracted from
two French observational databases. Bootstrap techniques were
implemented to drive the probabilistic sensitivity analyses.
RESULTS: MTTC was 44.3 months for travoprost and 37.7 for
latanoprost. Additional costs for Travatan were €52, leading to
an ‘incremental cost-effectiveness ratio’ (ICER) without treat-
ment change of €95 per year. 1.9% of patients treated with
latanoprost underwent laser treatment or surgery, compared to
1.2% with travoprost. Results varied with baseline IOP values
(≤20, 21 to 23, ≥24 mmHg) such that 55.6%, 53.9% and 50.4%
of patients, respectively, remained under travoprost treatment
when simulation ended, compared to 32.3%, 26.1% and 26.1%
under latanoprost. Thus ICERs, without treatment change, were
€140, €45, and €123 per year, respectively. CONCLUSION:
Travoprost yielded a longer effectiveness proﬁle and minimized
early treatment regimen changes. The smaller portion of patients
needing a new treatment, laser treatment or surgery virtually
compensated for the higher travoprost acquisition cost. Travo-
prost is a more cost-effective alternative, especially in patients
whose IOP at treatment onset lay between 21 and 23 mmHg.
PEY10
COST-EFFECTIVENESS OF TWO TREATMENT SEQUENCES IN
GLAUCOMA TREATMENT: XALATAN®-XALACOM® VERSUS
TRAVATAN®-DUOTRAV®
Maurel F1, Le pen C1, Berdeaux G2
1Aremis, Neuilly sur Seine, France, 2Alcon France, Rueil-Malmaison,
France
OBJECTIVES: To compare the costs and effectiveness of two
treatment sequences, Xalatan®-Xalacom® (X-X) versus Tra-
vatan®-DuoTrav® (T-D), in the treatment of glaucoma or ocular
hypertension (OHT). METHODS: A discrete event simulation
(DES) model was constructed. Patients with either glaucoma or
OHT were treated ﬁrst-line with a prostaglandin, either
Xalatan® or Travatan®. In case of treatment failure, patients
were switched to the speciﬁc prostaglandin-timolol sequence
Xalacom® or DuoTrav®. Failure was deﬁned as intraocular
pressure higher than 18 mmHg (Advanced Glaucoma Interven-
tion Study) at 2 visits. “Time to failure” was estimated from 
two randomized clinical trials (Xalatan® versus Travatan®,
Xalacom® versus DuoTrav®). Log-rank tests were computed.
Exponential functions were used to model “time to failure”. The
economic perspective was that of society in France. The time
horizon of the model was 60 months. Resource utilizations were
estimated from a national French observational survey. Out-
comes included treatment failure and disease progression. Sensi-
tivity analyses were performed. RESULTS: Xalatan® treatment
resulted in more treatment failures than Travatan® (p < 0.007),
and Xalacom® more than DuoTrav® (p < 0.04). At 60 months,
the probability of starting a third treatment line was 39.0% with
X-X versus 25.1% with T-D. On average, X-X patients devel-
oped 0.51 new visual ﬁeld defects versus 0.43 for T D patients.
The probability of no disease progression at 60 months was
64.2% with X-X and 69.2% with T-D. The 5-years costs of X-
X and T-D patients were 3220 euros and 3184 euros, respec-
tively (Travatan® price was 114% Xalatan®; Xalacom® 
and DuoTrav® prices were hypothesized as equal). CONCLU-
SIONS: Based on well-controlled randomized clinical trial results
and using a DES model, the T-D sequence was economically
dominant over the X-X sequence.
PEY11
MODELING THE COST AND CONSEQUENCES OF RESTOR®,A
MULTIFOCAL INTRAOCULAR LENS (IOL) IN REFRACTIVE
SURGERY IN FRANCE
Berdeaux G1, Lafuma A2, Guelfucci F3
1Alcon France, Rueil-Malmaison, France, 2Cemka-Eval, Bourd-la-Reine,
France, 3Cemka-Eval, Bourg-la-Reine, France
OBJECTIVE: To model the lifetime costs and consequences of
wearing spectacles versus implantation of ReSTOR® (a multi-
focal IOL), or other multifocal IOLs (MFIOLs), in the treatment
of presbyopia. METHODS: A Markov model followed subjects
from age 45 (presbyopia onset) to death. The prevalence rates of
patients without spectacles after ReSTOR® surgery and other
MFIOLs were taken from clinical trials. The number of cataract
operations avoided by presbyopia surgery (PS) and mortality
prevalence rates were estimated from national statistics.


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PEY10 COST-EFFECTIVENESS OF TWO TREATMENT SEQUENCES IN GLAUCOMA TREATMENT: XALATAN®-XALACOM® VERSUS TRAVATAN®-DUOTRAV®

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