PHARMACOECONOMICS OF OCULAR ANTI-INFECTIVE TREATMENTS

Abstract

Efforts to improve the overall quality and efficiency of medical care within limited budgets are ongoing across all medical specialties, including ocular infectious disease. As part of this movement, decision makers are requesting data regarding the value of medical treatments increasingly, in addition to traditional measures of efficacy and safety. The demand for value data within medical care has spurred the growth of outcomes research that is focused on the final end points of treatments, as opposed to intermediate end points, surrogate markers, or the structure and process of providing medical care. Value is a multidimensional concept that requires simultaneous assessment and balancing of many factors affecting the costs and benefits of a treatment. A model illustrating a decision-making structure for conducting multidimensional value assessments for medical interventions has been proposed by Kozma and colleagues. 6 The model includes three types of outcomes of medical care: economic, clinical, and humanistic outcomes (ECHO). Examples of variables within each outcome category are presented below.* *Adapted from Kozma CM, Reeder CE, Schulz RM: Economic, clinical, and humanistic outcomes: A planning model for pharmacoeconomic research. Clin Ther 15:1121–1132, 1993; with permission. Economic Outcomes Direct medical costs Cost of drug Cost of drug administration Cost of treating adverse events Direct nonmedical costs Transporation to clinic Indirect Costs Lost work days Decreased productivity Lost earnings Intangible costs Pain Suffering Clinical Outcomes Efficacy Onset of action Percentage of patients who become pain free Recurrence of symptoms Adverse events Humanistic Outcomes Health-related quality of life Return to normal functioning Satisfaction with therapy Some category examples may be relevant to a significant other or caregiver as well as the patient. The relevance of each type of outcome is dependent chiefly on the clinical characteristics of a disease. For example, the indirect cost of lost work days may be relevant in the treatment of a disease with debilitating symptoms, such as migraine, but have less relevance in a silent, less symptomatic disease, such as hypertension or glaucoma. Chronic diseases with high prevalence and expenditure rates have been first priority for identifying which treatments offer the most value by maintaining or improving quality of care in a cost-efficient manner. Many of these first-priority areas have been addressed to date, and the outcomes movement is now expanding to assess the value of treatments for acute or less prevalent diseases that have several alternative medical treatments available. Given the recent advances in therapies for many diseases of the eye, ophthalmologic treatments should be expected to come under increasing value scrutiny. Glaucoma is an obvious choice, given the number of recently introduced alternative treatments for this chronic disease that effects a growing segment of our population. Perhaps less obvious is the need to assess the comparative value of treatments for ocular infections that are less prevalent and generally of a more acute nature. Over the past few years, however, an increasing array of new, broader spectrum, higher cost treatments (antibacterials, antifungals, and antivirals) have become available, making relative value decisions more important. The purpose of this article is to describe the basic principles of pharmacoeconomic analyses that can be used to enhance the treatment selection process for ocular infections by including a value component.