• Eyedrops After Cataract Surgery: Costs and Prescribing Patterns

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD

    Journal Highlights

    Ophthalmology, May 2020

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    Zafar et al. looked at the costs and prescribing patterns for eyedrops after cataract surgery and estimated the savings of replacing brand drugs with generic or therapeutic options. They found that, in 2016, eyedrops were prescribed to 88% of Medicare patients who had cataract surgery. The total cost of these drugs exceeded $167 million during the study period, and brand products accounted for more than 75% of this amount. Substituting thera­peutic or generic alternatives could have saved up to $118 million, said the authors.

    For this retrospective cross-sectional study, the researchers evaluated Medicare Part D claims for patients who underwent cata­ract surgery in 2016. Outcomes were the cost of eyedrops used postoperatively, patient and physician factors linked to higher costs, and the potential savings of lower-cost options. For substitution, the most commonly prescribed generic medication in each drug class was used. For example, the authors considered generic ketorolac tromethamine as the alternative to nonsteroidal anti-inflam­matory drugs (NSAIDs).

    Of the 591,733 people who underwent cataract surgery that year, postoperative drops were prescribed for 520,688 (88%). Brand drugs accounted for 57.5% of the prescription volume and 76.5% of the total costs. Mean medication costs were $228 for those who underwent one operation and $324 for those who had two. The most commonly prescribed drugs were antibiotics (89%), steroids (86%), and NSAIDs (66%).

    Results of the cost analysis showed that using generic and therapeu­tic alternatives could have saved as much as $118 million, or 70% of total costs. In regard to patient factors, higher drug costs were associated with being older, being female, and being black, Asian, or Hispanic.

    Physician factors linked to higher costs included being female, practicing 10 or more years, and practicing in a metropolitan area.

    The authors concluded that in the absence of clinical evidence favoring brand products, less expensive drugs offer a viable opportunity to improve the value and cost of care after cataract surgery. They acknowledged that stud­ies are needed to compare the effects of different combinations of eyedrops to prevent such conditions as cystoid macular edema, rebound iritis, and dry eye syndrome.

    The original article can be found here.