Pharmacoeconomic analysis of brimonidine/timolol and travoprost 0.004% in the treatment of primary open angle glaucoma in Indian settings

Rekha Mehani, Vijay Kumar Yadav, Rajnish Kumar Sankadia, Sarang Ghodki, Tanu Garg


Background: As we know primary open angle glaucoma need lifelong treatment. It possess financial burden to patient. We have done this study to compare the monthly cost and cost effectiveness of brimonidine /timolol fixed combi-nation and Travoprost 0.004% eye drops in patients of primary open angle glaucoma.

Methods: Drops were dispensed at room temperature from 2.5-mL bottles of Travoprost, and 5ml of Brimonidine/Timolol. Two determinations of drop count were taken, each made from bottles held vertically and at a 45-degree angle. The total volumes of medication dispensed from each bottle were measured. Drops in five new bottles were counted and averaged for each drug. Drugs given to patients and asked them to come back with empty bottles for follow up after 2, 4, 8, 12 wks. IOP was measured and another bottle of drug is given. Average retail price was determined by survey of different brands available in market. Drop count, average retail price, and IOP reduction data were used to compute annual cost and cost effectiveness (annual cost per mmHg of IOP reduction) of both of the drugs.

Results: Drops per 2.5ml bottle averaged 83 for Travoprost 0.004% and 100 drops per 5ml bottle for Brimonidine/Timolol. Average retail cost per bottle was 498 for Travoprost 0.004% and 204 for Brimonidine/Timolol. Annual re-tail cost was 3545 for Brimonidine/Timolol and 4910 for Travoprost 0.004%. Cost effectiveness ranges were 328 to 361 for Brimoni-dine/Timolol and 629 to 637 for Travoprost 0.004%.

Conclusions: Brimonidine/Timolol had the lower monthly cost and annual cost and it is more cost effective than Travoprost 0.004%.


Pharmacoeconomic analysis, Travoprost, Brimonidine/Timolol, cost effec-tiveness, IOP

Full Text:



Quigley HA. Number of people with glaucoma worldwide.Br J Ophthalmol. 1996;80:389-93.

Palimkar A, Khandekar R, Venkataraman V. Prevalence and distribution of glaucoma in central India (Glaucoma Survey - 2001), Indian J Ophthalmol. 2008;56(1):57-62.

Resnikofff S, Pascolini D, Etya'ale D. Global data on visual impairment in the year 2002. Bull World Health Organ. 2004;82844-851.

Heijl A, Leske MC, Bengtsson B. Early Manifest Glaucoma Trial Group. Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial, Arch Ophthalmol. 2002;120:1268-79.

Leske MC, Heijl A, Hussein M. Early Manifest Glaucoma Trial Group. Factors for glaucoma progression and the effect of treatment: the early manifest glaucoma trial, Arch Ophthalmol. 2003;121:48-56.

The Advanced Glaucoma Interventions Study (AGIS): The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration. The AGIS Investigators, Am J Ophthalmol. 2000;130:429-40.

Kass MA, Heuer DK, Higginbotham EJ. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma, Arch Ophthalmol. 2002;120:701–13.

Lee PP, Walt JG, Doyle JJ. A multicenter, retrospective pilot study of resource use and costs associated with severity of disease in glaucoma. Arch Ophthalmol. 2006;124(1):12-9.

Rein DB, Wittenborn JS, Lee PP. The cost-effectiveness of routine office-based identification and subsequent medical treatment of primary open-angle glaucoma in the United States. Ophthalmology. 2009;116(5):823-32.

Stewart WC, Stewart JA, Nasser QJ, Mychaskiw MA. Cost-effectiveness of treating ocular hypertension. Ophthalmology. 2008;115(1):94-8.

Kymes SM, Kass MA, Anderson DR. Management of ocular hypertension: a cost- effectiveness approach from the Ocular Hypertension Treatment Study. Am J Ophthalmol. 2006;141(6):997-1008.

Taylor HR, Pezzullo ML, Nesbitt SJ, Keeffe JE. Costs of interventions for visual impairment. Am J Ophthalmol. 2007;143(4):561-5.

Kobelt G. Health economics: an introduction to economic evaluation. 2nd ed. London: Office of Health Economics. 2002.

Lachaine J, Hodge WG, Steffensen I, Murray C, Barnes D, Forester V, et al. Prostaglandin analogues for ophthalmic use: a cost- effectiveness analysis. Can J Opthalmol. 2008;43(1):33-41.

Guzman R, Tosti A, Hay R, Haneke E, Pharmacoeconomics - an aid to better decision-making, Journal of the European Academy of Dermatology and Venereology. 2005;19:34-71.

Hommer A, Thygesen J, Ferreras A, Wickstrom J, Friis MM, Buchholz P. A European perspective on costs and cost effectiveness of ophthalmic combinations in the treatment of open-angle glaucoma. Eur J Ophthalmol. 2015;18(5):778-86.

Global Glaucoma Treatment Market: Trends and Opportunities by Daedal Research Market Research Report. 2014-2019. At

Orme M, Collins S, Loftus J. Long-term medical management of primary openangle glaucoma and ocular hypertension in the UK: optimizing cost-effectiveness and clinic resources by minimizing therapy switches. J Glaucoma. 2012;21:433-49.

Dirani M, Crowston JG, Taylor PS, Moore PT, Rogers S, Pezzullo ML. Economic impact of primary open-angle glaucoma in Australia. Clin Experiment Ophthalmol. 2015;39(7):623-32.

Kobelt-Nguyen G, Gerdtham UG, Alm A. Costs of treating primary open-angle glaucoma and ocular hypertension: a retrospective, observational two-year chart review of newly diagnosed patients in Sweden and the United States. J Glaucoma. 1998;7(2):95-104.