Medical therapy cost considerations for glaucoma

PURPOSE: To determine the calculated daily patient cost (cost minimization) of medical glaucoma therapy and review cost trends. DESIGN: Experimental, controlled, prospective study. METHODS: The actual volume of various glaucoma medications or glaucoma medications with redesigned bottles was determined for most commercially available sizes of the tested products. The drops per milliliter based on the actual volume and the daily costs of the dosage schedules recommended by the manufacturers were compared. The cost of each bottle of medication was determined from the average wholesale price (AWP) in the United States. A comparison to 1999 prices where applicable will be analyzed to review costing trends. RESULTS: The generic timolol products (range, $0.38-$0.46 per day) were similar on a cost per day basis vs Betimol (Santen, Napa Valley, California, USA), Optipranolol (Bausch and Lomb Pharmaceuticals, Tampa, Florida, USA) and Timoptic (Merck, West Point, Pennsylvania, USA). Their percentage cost increase ranged from 5% to 22% since 1999, except for generic timolol XE gel-forming solution (48%). Betagan (Allergan, Irvine, California, USA), Betoptic S (Alcon Laboratories, Fort Worth, Texas, USA), and Ocupress (Novartis, Duluth, Georgia, USA) ranged from $0.88 to $1.11 per day, and their percentage cost increase ranged from 33% to 53%. Some brand-only products have raised their AWPs a greater percentage, including Betoptic S (37%), Iopidine (Alcon, Fort Worth, Texas, USA) (50%), Ocupress (Novartis Ophthalmics, Duluth, Georgia, USA) (53%), and Pilopine gel (Alcon, Fort Worth, Texas, USA) (32%). The mean cost per day for the topical carbonic anhydrase inhibitors Azopt (Alcon Laboratories; $1.33 per day) and Trusopt (Merck; $1.05 per day) differed from 1999 when prices were almost identical. Cosopt (Merck; timolol 0.5% plus dorzolamide 2%, $1.04 per day) was less than the cost of separate bottles of a topical carbonic anhydrase inhibitor and a 0 blocker. The selective alpha-2 agonist brimonidine 0.15% with Purite (Alphagan,P, Allergan, 5 ml) twice daily was $1.29 per day. The prostaglandin analogs were comparably priced with Lumigan (Allergan) $0.95 per day, Xalatan (Pharmacia and Upjohn, Kalamazoo, Michigan, USA) $1.25 per day, Travatan (Alcon Laboratories) $1.01 per day, and Rescula (Novartis) $0.90 per day. 0 CONCLUSIONS: All generic timolol, Betimol, Optipranolol, Timoptic, and Timoptic XE (Merck) ranged from $0.38 to $0.50 per day. Other beta-blocker products were about twice as costly, ranging from $0.88 to $1.11 per day. Cosopt ($1.05 per day) was less costly than separate bottles of a topical P-blocker and a topical carbonic anhydrase inhibitor dosed three times daily or twice daily. The prostaglandin analogs ranged from $0.90 per day (Rescula) to $1.25 per day (Xalatan). Newer glaucoma medications exhibit similar costs per day in many cases, compared with more traditional medications, especially with greater price increases in older brand,only products. (Am J Ophthalmol 2003;136:18-25. (C) 2003 by Elsevier Inc. All rights reserved.).