Current Knowledge and Attitudes Concerning Cost-Effectiveness in Glaucoma Pharmacotherapy: A Glaucoma Specialists Focus Group Study

Background: Rising healthcare costs motivate continued cost-reduction efforts. To help lower costs associated with open-angle glaucoma (OAG), a prevalent, progressive disease with substantial direct and indirect costs, clinicians need to understand the cost-effectiveness of intraocular pressure (IOP)-lowering pharmacotherapies. There is little published information on clinicians ’ knowledge and attitudes about cost-effectiveness in glaucoma treatment. Purpose: This pilot focus group study aimed to explore clinician attitudes and perspectives around the costs and cost drivers of glaucoma therapy; the implementation of cost-effectiveness decisions; the clinical utility of cost-effectiveness studies; and the cost-effectiveness of available treatments. Methods: Six US glaucoma specialists participated in two separate teleconferencing sessions (three participants each), managed by an independent, skilled moderator (also a glaucoma specialist) using a discussion guide. Participants reviewed recent publications (n=25) on health economics outcomes research in glaucoma prior to the sessions. Results: Participants demonstrated a clear understanding of the economic burden of glaucoma therapy and identi ﬁ ed medications, diagnostics, of ﬁ ce visits, and treatment changes as key cost drivers. They considered cost-effectiveness an appropriate component of treatment decision-making but identi ﬁ ed the need for additional data to inform these decisions. Participants indicated that there were only a few recent studies on health economics outcomes in glaucoma which evaluate parameters important to patient care, such as quality of life and medication adherence, and that longitudinal data were scant. In addition to ef ﬁ cacy, participants felt patient adherence and side-effect pro ﬁ le should be included in economic evaluations of glaucoma pharmacotherapy. Recently approved medications were evaluated in this context. Conclusion: Clinicians deem treatment decisions based on cost-effectiveness data as clinically appropriate. Newer IOP-lowering therapies with potentially greater ef ﬁ cacy and favor-able side-effect and adherence pro ﬁ les may help optimize cost-effectiveness. Future studies should include: clinicians ’ perspectives; lack of commercial bias; analysis of long-term outcomes/costs; more comprehensive parameters; real-world (including quality-of-life) data; and a robust Markov model. economics outcomes research glaucoma; glaucoma prostaglandin analogs cost-effectiveness; intraocular pressure-lowering glaucoma cost-effectiveness; open-angle glaucoma cost burden; open-angle glaucoma pharmacoeconomics; glaucoma care cost burden. The search was limited to English-language articles published within the past 15 years. Primary health economic research studies concerningmedicalglaucomatherapy,especiallyprostaglandinanalogs(PGAs),andnarrativeorsystematicreviewarticlesonglaucomaeconomicswereidenti ﬁ ed,withprioritygivento thosepublishedmorerecentlyand/orinvolvingsomeofourpotentialparticipantsasauthorsandthosethattookplaceintheUSandEurope.Selectedreferenceswerereviewedbythe focus group moderator to ensure that key publications taken into account.