Treatment patterns in open-angle glaucoma patients post initial diagnosis, under a public insurance drug program in Quebec, Canada.
Authors: Hady Saheb1, Paul Harasymowycz2, Kahina Matougui3, Bijah Shah-Manek4. 1McGill University, 2Université de Montréal, 3Abbvie Corporation, 4Noesis Healthcare Technologies.
Author Disclosures: H. Saheb: Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Alcon, Abbvie, Bausch, Glaukos, Novartis, Sun Pharma. Any direct financial payments including receipt of honoraria; Description of relationship(s); Consultant. P. Harasymowycz: Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Abbvie. Any direct financial payments including receipt of honoraria; Description of relationship(s); Consultant. K. Matougui: All other investments or relationships that could be seen by a reasonable, well-informed participant as having the potential to influence the content of the educational activity; Name of for-profit or not-for-profit organization(s); Abbvie. All other investments or relationships that could be seen by a reasonable, well-informed participant as having the potential to influence the content of the educational activity; Description of relationship(s); Employee. B. Shah-Manek: All other investments or relationships that could be seen by a reasonable, well-informed participant as having the potential to influence the content of the educational activity; Name of for-profit or not-for-profit organization(s); Noesis Healthcare Technologies. All other investments or relationships that could be seen by a reasonable, well-informed participant as having the potential to influence the content of the educational activity; Description of relationship(s); Employee.
Abstract Body:
Purpose: To describe how newly diagnosed open angle glaucoma (OAG) patients are managed under a public drug insurance program.
Study Design: A retrospective provincial level health care analysis using the Quebec (Régie de l’Assurance Maladie du Québec, RAMQ) medical and pharmaceutical services database. RAMQ is a public universal health care program that covers physician services and prescription claims.
Methods: OAG was defined using ICD-9 codes 365.1 or 365.0 and patients were required to have no glaucoma medication/procedure in the year preceding the index date (date of the first OAG diagnosis). Follow-up was 2 years and study recruitment extended from May 2010 to April 2020. Escalation was defined as the first change or addition in glaucoma treatment class or the occurrence of an eye procedure. Patients initiating treatment with 2 years of follow-up were classified by type of first-line treatment and rates of treatment escalation.
Results: The treated cohort consisted of 5400 OAG patients with a mean age of 72 years and 45% male. Comorbidities and mean age were similar across the first-line cohorts: monotherapy, combination, eye procedures. Prostaglandins (PGN) constituted 83.1% of monotherapy Rx’s as first line. During follow-up, 646/2564 (25.2%) of monotherapy first line subjects added or switched to a new class. For combination 1st line (N=2237), the largest group (36.9%) were prescribed a prostaglandin + B-blocker. Eye procedures were minimal (11%, [599/5400]) in the year following diagnosis, with SLT being highest (574/599).
Conclusions: There was low use of procedures and eye drops dominated 1st-line treatment. Identifying an unmet need, a high proportion of monotherapy patients escalated within 2 years.
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