Studies: Comfort, cost may affect patient compliance with medication regimen

The lower price of over-the-counter anti-allergy drops may affect compliance, as may the increased comfort of prescription agents.

William Edmondson

Results from studies comparing ophthalmic anti-allergy drops in terms of comfort and cost suggested that while prescription drops had higher comfort ratings, the significantly lower cost of the over-the-counter drops may contribute to their being a viable and cost-efficient alternative.

“The reason clinicians worry about the comfort and cost is that if the patient puts in a drop and it stings, that may have an influence on compliance,” William Edmondson, OD, FAAO, professor of ocular pharmacology at the Southern College of Optometry, said in an interview with Primary Care Optometry News.

In one study, presented at Academy 2011, Dr. Edmondson and colleagues compared comfort and cost of four over-the-counter anti-allergy ophthalmic solutions of 0.025% ketotifen fumarate: Zaditor (Novartis), Alaway (Bausch + Lomb), Claritin Eye (MSD Consumer) and Zyrtec Itchy Eye Drops (McNeil). Subjects in this double-masked trial included 51 patients in their 20s.

In another study, presented at Optometry’s Meeting 2011, Zaditor, Alaway, Bepreve (1.5% bepotastine besilate, Ista) and Pataday (0.2% olopatadine, Alcon), which are all mast-cell stabilizers and antihistamines, were evaluated in a group of 36 patients.

According to both study abstracts, all patients were administered surveys to rate their comfort on a scale of 1 to 10, with 10 being the best comfort. As a reference, TheraTears (Advanced Vision Research) was instilled, and subjects were told to consider this a comfort level of 10.

After TheraTears instillation, anti-allergy drops were then instilled in the subject’s right eye, in random order, 8 minutes apart.

For purposes of these studies, the authors noted that they obtained medication costs from the websites www.drugstore.com and www.epocratesonline.com. “Based on dosing in both eyes and the standard estimate of 20 drops/mL, the cost per day for each medication was calculated,” the authors stated. “Pataday is dosed once daily, while all of the others are twice a day.”

In the study comparing the four ketotifen agents, Zaditor, Claritin Eye and Zyrtec Itchy Eye Drops were rated as significantly more comfortable than Alaway. “However, Alaway, with a 10-mL bottle, had the lowest treatment cost per day,” the study authors stated.

“The question was,” Dr. Edmondson said in the interview, “because there’s a difference in comfort, should you be making a suggestion of which OTC agent to use?”

Dr. Edmondson noted that he has been unable to determine that Claritin Eye and Zyrtec Itchy Eye Drops are still available.

In the other study, Bepreve and Pataday, the two prescription agents, showed comparable comfort levels, both achieving a mean comfort rating of about 7, according to the study results. Zaditor, now available over the counter but formerly a prescription agent, was rated significantly less comfortable than the prescription drops (about a 5), but significantly more comfortable than Alaway, which had a mean comfort rating of about 3.

Alaway, however, is the most cost-efficient drop, according to the study, costing only about $0.50 a day. Zaditor is twice the cost of Alaway, but significantly less expensive than the prescription drops Bepreve and Pataday (about $3.30 and $4.10 per day, respectively).

“Of course, an individual patient’s insurance coverage of prescription medications would impact out-of-pocket expense,” Dr. Edmondson added.

A patient with insurance and a $50 co-pay will find the cost per day of prescription Bepreve ($0.75) to be comparable to the cost per day of Zaditor, according to the study findings.

“The prescription agents were significantly more comfortable than any of the over-the-counter products,” Dr. Edmondson summarized, “but they are prescription, which ensures that they’ll be more expensive per day.

“So I think the doctor can decide, by talking with a patient, whether they would be more interested in doing prescription meds or the over-the-counter drops,” he said.

Dr. Edmondson said that he and his colleagues plan to do further studies when new agents are released. – by Daniel R. Morgan

References:

• Edmondson W. McKee E, Baldwin M, et al. Do we need to Rx specific brands of OTC ketotifen drops? Comparisons of comfort & cost with anti-allergy drops. Poster presented at Academy 2011; October 2011; Boston, MA.
• Spears K, Edmondson W, McKee E. Anti-allergy drop comfort and cost. Poster presented at Optometry’s Meeting; June 2011; Salt Lake City, UT.

• William Edmondson, OD, FAAO, can be reached at Ocular Pharmacology & Clinical Cornea, Contact Lens Care, Southern College of Optometry, 1245 Madison Ave., Memphis, TN 38104; (901) 722-3390; wedmondson@sco.edu.
• Disclosures: Dr. Edmondson has no relevant financial disclosures.