• Glaucoma

    In the January edition of the American Journal of Ophthalmology, Steven D. Vold, MD, revisits an issue he's considered in previous retrospective studies - the yearly cost of glaucoma medications.

    This time, Dr. Vold and colleagues took a prospective approach. Using the average wholesale price and common dosing patterns, they  determined that the yearly cost of glaucoma medications ranged from $150.81 for generic timolol maleate 0.5% to $697.42 for Cosopt, and as high as $873.98 for a three-times-daily dose of Alphagan P 0.15%.

    Having closely monitored patient medication costs for years, Dr. Vold's results generally confirmed his clinical impressions. Nonselective β-blockers remain the most inexpensive class of glaucoma medications.

    Among brand name ß-blockers, yearly cost ranged between $203.47 for Timoptic 0.5% and $657.24 for Betoptic S. Generic ß-blockers consistently were more economical than their brand-name counterparts. Yearly cost of prostaglandin analogs ranged from $427.69 for Travatan to $577.62 for Lumigan. The two carbonic anhydrase inhibitors, Azopt and Trusopt, yielded similar economic profiles. The generic selective α2-agonist brimonidine tartrate 0.2% costs approximately $352.89 and $529.34 per year for the respective two and three drops daily per eye regimens.

    AWP trends through two periods, 1999 to 2006 and 2002 to 2006, showed significant increases, even within a category. For example, in the ß-blockers, Betoptic S increased nearly 100 % from 1999 to 2006, while Timoptic, increased only 11.7 %. In the period 2002 to 2006, the AWP of Timoptic remained constant.

    One finding that may surprise some physicians is that bottle size may significantly influence annual medication costs in some cases, Dr. Vold said.

    Dr. Vold found that although the larger bottles of medication might not have the lowest per year price, they may be desirable to patients who pay a fixed copay per medication purchased. Prices also vary between pharmacies, so the patient is encouraged to shop around for the best price.

    "I feel a certain obligation to research medication cost issues for my patients," Dr. Vold said. "This information allows me to discuss this issue directly with my patients, and provide them the most cost-effective glaucoma care available."

    In the United States, the management of glaucoma costs about $2.5 billion per year. Of the $1.9 billion in direct costs, glaucoma medications account for an estimated 38% to 52% of the total.