To determine the calculated daily patient cost (cost minimization) of medical glaucoma therapy and review cost trends.Experimental, controlled, prospective study.The actual volume of various glaucoma medications or glaucoma medications with redesigned bottles was determined for most commercially available sizes of the tested products. The drops per milliliter based on the actual volume and the daily costs of the dosage schedules recommended by the manufacturers were compared. The cost of each bottle of medication was determined from the average wholesale price (AWP) in the United States. A comparison to 1999 prices where applicable will be analyzed to review costing trends.The generic timolol products (range, US dollars 0.38-US dollars 0.46 per day) were similar on a cost per day basis vs Betimol (Santen, Napa Valley, California, USA), Optipranolol (Bausch and Lomb Pharmaceuticals, Tampa, Florida, USA) and Timoptic (Merck, West Point, Pennsylvania, USA). Their percentage cost increase ranged from 5% to 22% since 1999, except for generic timolol XE gel-forming solution (48%). Betagan (Allergan, Irvine, California, USA), Betoptic S (Alcon Laboratories, Fort Worth, Texas, USA), and Ocupress (Novartis, Duluth, Georgia, USA) ranged from US dollars 0.88 to US dollars 1.11 per day, and their percentage cost increase ranged from 33% to 53%. Some brand-only products have raised their AWPs a greater percentage, including Betoptic S (37%), Iopidine (Alcon, Fort Worth, Texas, USA) (50%), Ocupress (Novartis Ophthalmics, Duluth, Georgia, USA) (53%), and Pilopine gel (Alcon, Fort Worth, Texas, USA) (32%). The mean cost per day for the topical carbonic anhydrase inhibitors Azopt (Alcon Laboratories; US dollars 1.33 per day) and Trusopt (Merck; US dollars 1.05 per day) differed from 1999 when prices were almost identical. Cosopt (Merck; timolol 0.5% plus dorzolamide 2%, US dollars 1.04 per day) was less than the cost of separate bottles of a topical carbonic anhydrase inhibitor and a beta-blocker. The selective alpha-2 agonist brimonidine 0.15% with Purite (Alphagan-P, Allergan, 5 ml) twice daily was US dollars 1.29 per day. The prostaglandin analogs were comparably priced with Lumigan (Allergan) US dollars 0.95 per day, Xalatan (Pharmacia and Upjohn, Kalamazoo, Michigan, USA) US dollars 1.25 per day, Travatan (Alcon Laboratories) US dollars 1.01 per day, and Rescula (Novartis) US dollars 0.90 per day.All generic timolol, Betimol, Optipranolol, Timoptic, and Timoptic XE (Merck) ranged from US dollars 0.38 to US dollars 0.50 per day. Other beta-blocker products were about twice as costly, ranging from US dollars 0.88 to US dollars 1.11 per day. Cosopt (US dollars 1.05 per day) was less costly than separate bottles of a topical beta-blocker and a topical carbonic anhydrase inhibitor dosed three times daily or twice daily. The prostaglandin analogs ranged from US dollars 0.90 per day (Rescula) to US dollars 1.25 per day (Xalatan). Newer glaucoma medications exhibit similar costs per day in many cases, compared with more traditional medications, especially with greater price increases in older brand-only products.

To determine the readability of ocular medication inserts and whether they are an appropriate source of medication information for patients.The Flesch-Kincaid and SMOG readability formulas were used to calculate the readability of 10 common glaucoma medication inserts (Alphagan, Azopt, Betoptic, Betimolol, Cosopt, Optipranolol, Rescula, Trusopt, Timoptic, and Xalatan) and 6 widely used nonglaucoma medication inserts (Alrex, Lotemax, Ocuflox, Patanol, Pred Forte, and Zaditor).The 10 glaucoma medication inserts surveyed required an average overall grade level of 12.9 +/- 0.6 by the Flesch-Kincaid Index and of 13.5 +/- 0.6 by the SMOG formula. The 6 nonglaucoma medication inserts had an overall grade level of 11.1 +/- 0.6 by the Flesch-Kincaid Index and of 11.7 +/- 0.9 by the SMOG formula. All medications reviewed were above the eighth-grade level recommended by the Flesch-Kincaid Index for public materials.Ocular medication inserts are too complex to be an adequate source of medication information for the average American adult. This study highlights the need for improving communication and education regarding patients' medications.

To evaluate yearly cost of glaucoma medications at a university-affiliated teaching hospital with its own health maintenance organization from 1998 through 2000.We retrieved data from the Scott and White prescription claims file for 1,484 patients concerning Health Plan glaucoma-medication prescriptions for the years 1998 through 2000. Patient inclusion criteria were as follows: 1) use of a single or fixed-combination topical glaucoma medication during all four quarters of at least one full-year, 2) treatment of both eyes, 3) participation in the Health Plan prescription program, and 4) prescriptions filled at pharmacies participating in the Health Plan prescription program.Over this 3-year period, the most costly medication per patient per year was dorzolamide hydrochloride-timolol maleate (Cosopt; Merck, West Point, PA [$470]), followed by betaxolol hydrochloride (Betoptic-S; Alcon, Fort Worth, TX [$370]), latanoprost (Xalatan; Pharmacia and Upjohn, Kalamazoo, MI [$352]), dorzolamide hydrochloride (Trusopt; Merck, West Point, PA [$288]), brimonidine tartrate (Alphagan; Allergan Pharmaceuticals, Irvine, CA [$273]), brinzolamide (Azopt; Alcon, Fort Worth, TX [$243]), timolol maleate 0.5% in a gel-forming solution (Timoptic-XE 0.5%; Merck, West Point, PA [$190]), carteolol hydrochloride (Ocupress; Otsuka Pharmaceutical, Rockville, MD [$183]), generic levobunolol hydrochloride 0.5% ($138), metipranolol (Optipranolol; Bausch and Lomb Pharmaceuticals, Tampa, FL [$135]), and generic timolol maleate 0.5% ($133).Differences in yearly cost exist among topical glaucoma medications.

With the recent addition of several new ocular hypotensive agents to the pharmacopeia, glaucomatologists have more choices in selection of pharmacotherapy. Several of these new agents have special storage requirements or a limited shelf-life when stored under certain conditions.To better inform physicians and patients about pharmaceutical issues relating to the correct usage or storage of ophthalmic products used to manage glaucoma, the authors reviewed the US Food and Drug Administration requirements for sterile ophthalmic preparations, together with the United States Pharmacopeia 24. They also reviewed the Ophthalmic Physicians Desk Reference (2000 edition) for pharmaceutical information regarding branded glaucoma-solution products.The US Food and Drug Administration requires that both analytical tests (e.g., concentration of preservative) and functional tests (e.g., preservative efficacy tests) be undertaken to show the sterility of liquid products. In addition, extensive chemical testing of the potency and stability of the active molecule and other physicochemical properties of the formulation are needed to justify expiration dates and determine the shelf-life of the product. Of the 19 products that met the search criteria, 17 (89%) used benzalkonium chloride as the primary preservative agent, in weight-to-volume ratios ranging from 0.004% (Betagan, Optipranolol) to 0.020% (Xalatan). Five products had a warning against freezing, and 12 required protection from light. Only one product required refrigerated storage before opening, though most products specify an upper range for temperature exposure during storage.Physicians and their patients need to be aware of the special requirements of each product to assure that they receive the dose of medication as prescribed. The distinction between stability during storage before dispensing (shelf-life) and the acceptable "in-use life" after opening of the dispensed product are essential for the safe and efficacious management of glaucoma.

To determine the calculated daily patient cost (cost minimization) of medical glaucoma therapy.The actual volume of various glaucoma medications was determined for all commercially available sizes of the tested products. The drops per ml on the basis of the actual volume and the daily costs of the dosage schedules recommended by the manufacturers were compared. The cost of each bottle of medication was determined from the average wholesale price in the United States.The generic timolol products dosed twice daily and the once-daily gel-forming solutions (range, $0.30 to $0.46/day) were similar on a cost-per-day basis compared with the brand name metipranolol (Optipranolol; Bausch & Lomb Pharmaceuticals, Tampa, Florida, at $0.43/day) and timolol (Timoptic; Merck, West Point, Pennsylvania, at $0.46/day and Timoptic XE at $0.38/ day). Betaxolol (Betoptic S; Alcon Laboratories, Fort Worth, Texas, at $0.65/day), carteolol (Ocupress; CibaVision, Duluth, Georgia, at $0.57/day), levobunolol ($0.61/day), and brand name levobunolol (Betagan; Allergan, Irvine, California, at $0.81/day) all were dosed twice daily and were more costly on a per-day basis. The topical carbonic anhydrase inhibitors brinzolamide (Azopt; Alcon, at $0.96/day) and dorzolamide (Trusopt; Merck, at $1.02/day) were dosed three times daily and were similar on a cost-per-day basis. The combination product Cosopt (timolol 0.5% + dorzolamide 2.0%, Merck, at $1.12/day) was less costly than separate bottles of a topical carbonic anhydrase inhibitor (three times daily dosing) and a beta-blocker ($1.26 to $1.83/day), often even if the topical carbonic anhydrase inhibitor was dosed two times daily ($0.94 to $1.49). The selective alpha2-agonist brimonidine (Alphagan; Allergan, at $0.90/day) twice daily and the prostaglandin analog latanoprost (Xalatan; Pharmacia & Upjohn, Kalamazoo, Michigan, at $0.92/day) once daily were similarly priced.All generic timolol, Optipranolol, Timoptic, and Timoptic XE ranged between $0.30 and $0.46 per day. Betaxolol, Ocupress, generic levobunolol, and Betagan were more costly, ranging between $0.57 and $0.81 per day. Cosopt ($1.12/day) was less costly than separate bottles of a topical beta-blocker and a topical carbonic anhydrase inhibitor dosed three times daily ($1.26 to $1.83/day) and often twice daily ($0.94 to $1.49). Alphagan and Xalatan were similarly priced ($0.90/day and $0.92/day, respectively). This study is based on a best-case scenario for all medicines and does not account for wasted doses, the frequency of refills, or a medication's success or failure rate. New adjunctive glaucoma regimens exhibit similar costs per day compared with more traditional regimens.

To evaluate the daily cost of beta-blocker therapy among commercially available products.Ten different beta-adrenergic blocker preparations, each in 10-mL bottles (except Timoptic-XE [Merck brand of timolol maleate gel-forming solution], which was in a 5-mL bottle), were acquired from a local pharmacy. Each of 10 subjects dispensed 10 drops from each bottle onto an analytical scale. The mean drop volume for each preparation was then calculated. The fill volume of each bottle and the amount of each medicine that was wasted upon dispensing also were determined. Additionally, 60 pharmacies in the United States were randomly chosen to determine the average cost of each preparation studied. Based on all data obtained, an average daily cost of each medicine was calculated.The generic formulation of timolol maleate (Falcon) ($0.55) and Betimol (Ciba Vision Ophthalmics brand of timolol hemihydrate) ($0.57) demonstrated the lowest cost per day of therapy. In contrast, Betoptic-S (Alcon brand of betaxolol hydrochloride) ($1.60) and Betagan (Allergan brand of levobunonol hydrochloride) ($1.35) had the highest daily cost of therapy. Ocupress (Otsuka America brand of carteolol hydrochloride) had the smallest drop volume (31 microL) and Timoptic-XE had the highest (49 microL). Most preparations were close to their stated bottle fill volume. The amount of wasted medicine varied and was least with Ocupress (27%) and greatest with Betoptic-S (54%). The mean pharmacy price for a 10-mL bottle was lowest for OptiPranolol (Bausch & Lomb brand of metipranolol) ($25.51) and Betimol ($28.28); Betoptic-S ($44.80) and Betagan ($43.67) were the most expensive.Although all commercially available beta-adrenergic blockers effectively lower intraocular pressure, one differential factor between medicines is cost, which may be influenced by the price at the pharmacy, volume of medication per bottle, drop size, and medicine wastage.

We compared the cost per drop and cost per year of therapy for five commercially available ocular beta-blockers (Timoptic, Betagan, Betoptic, Betoptic S, and Optipranolol) based on retail prices in Philadelphia, Pa; New Orleans, La; and San Francisco, Calif. Variations in bottle volumes and drop size combined to yield up to a 48% differential in number of drops per bottle. Average retail price variations were 28% within brands (between pharmacies), 29% between brands, and 29% between regions. Yearly costs were consistently less with larger bottles. Factoring drops-per-bottle, cost of brand, and cost by pharmacy, the cost of a year's supply of beta-blocker in 5-mL bottles in the least expensive region (New Orleans) ranged from $52.25 for Optipranolol to $278.91 for Betagan (534% of the price for Optipranolol). The marked differential in yearly cost among antiglaucoma medications should perhaps be a factor in the recommendations made by physicians and health-care providers.