How prostaglandins have changed the medical approach to glaucoma and its costs: an observational study of 2228 patients treated with glaucoma medications.

Abstract: Purpose: The aim of the present study was to investigate how the medical treatment of glaucoma changed between 1997 and 2002, since the advent of prostaglandin derivatives, with regard to drug prescriptions and pharmaceutical costs. Methods: A study was made of medical prescriptions for 2228 patients with glaucoma and/or ocular hypertension, in order to investigate the following: (i) the antiglaucoma drugs most commonly prescribed in 1997 and 2002, and any differences between the drugs prescribed in these 2 years; (ii) the number of drugs used per patient in 1997 and 2002, respectively, and (iii) any increase in the prescribing of antiglaucoma drugs and their relative costs from 1997 to 2002. Results: From 1997 to 2002 there was a sharp drop in the prescribing of beta-blockers (79% in 1997 and 55% in 2002). A marked increase in the use of prostaglandin derivatives (0% in 1997 and 18% in 2002) was registered and a marked increase in the prescribing of carbonic anhydrase inhibitors (5% in 1997 and 14% in 2002) was also noted. From 1997 to 2002 there was a trend towards drug addition rather than substitution, so that the number, of drugs used per patient increased. The number of patients treated increased enormously (by 98%) from 1097 to 2002. The cost of medical therapy from 1997 to 2002 rose dramatically, with an increase of 148.9% per patient. Conclusion: The availability of prostaglandin derivatives has strongly influenced the medical approach to glaucoma. This class of drugs win soon become the type most commonly prescribed for patients with glaucoma and/or ocular hypertension. The increased number. of treatments also suggests that the approach of ophthalmologisis towards these diseases has changed. Ocular hypertension, as well as glaucoma, is now treated more aggressively. Given the increase in the prescription of prostaglandin derivatives, the pharmaceutical cost of treatment has risen dramatically.