Effectiveness and Costs of Antiglaucoma Medications

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Abstract
Seventy-one unselected patients with newly diagnosed open angle glaucoma were included in a prospective multicenter study of medical treatment, intraocular pressure response, and adverse drug reactions. Standard data were recorded by the eight ophthalmologists at five visits over a mean interval of 1 year. There was a statistically significant initial intraocular pressure reduction (7.64 mmHg), but thereafter no change in mean pressure despite 99 drug changes in medication for 67 eyes. There was no statistically significant difference in the effectiveness of the different medications prescribed when evaluated using usefulness quotients. Experimentally derived usefulness quotients were almost identical to previously described estimates of usefulness products of drugs. The cost of treatment ranged from $0.85 to $30.22 per month per eye treated (mean $5.81), and increased in correlation with the number of treatment changes. Cost-effectiveness (monthly cost/usefulness quotient) calculated for the most frequently prescribed drugs showed pilocarpine to be superior to timolol. Lack of further significant intraocular pressure reduction after the initial response; equal survival curves for the first, second, and third drugs; continuing risk of adverse reactions; and die variability in intraocular pressure around the patient's mean pressure are factors to be considered before changing drugs and thereby increasing patients' costs.