rx perspective
The Economics of Using Restasis
Therapy with cyclosporine 0.05% brings real relief -- and can save doctors and dry eye patients time and money.
By Eric D. Donnenfeld, M.D.

In the past, dry eye patients were often seen as a nuisance -- chronic complainers whom no amount of treatment seemed to satisfy. Despite trying to help these patients with everything in our arsenals (tears, gels, ointments, steroids, plugs, NSAIDS, etc.) nothing provided anything beyond temporary symptomatic relief.

Thanks to Restasis, there's no longer any reason to view these patients as nuisances, or to think of finding an effective treatment for dry eye disease as problematic.

Economic Benefits

At this point the therapeutic benefits of Restasis are increasingly well known and accepted by the medical community, but -- because of the cost -- there's less consensus about whether it's economically practical to prescribe it.

These concerns, however, fail to take into account many positive economic considerations. As Warren Cross, M.D., senior surgeon and co-researcher at the Bellaire Eye and Laser Center in Houston, noted in his article on this subject in Managed Care Interface in September 2002, "There is a concern about the price of Restasis that is unfounded."

In fact, the positive effect of Restasis on the economics of eye care and on managed care should be huge. Benefits connected with the use of Restasis include:

Fewer doctor visits. Patients save money on co-pays because they no longer need to visit their eyecare professional again and again in a continuing search for relief from dry eye symptoms.

In Cross' retrospective study of 181 patients using cyclosporine for dry eye, 1,800 office visits were recorded in the 2 years before enrollment in the cyclosporine trials. These visits were specifically motivated by dry eye complaints ("for cause" visits).

After these same patients began using cyclosporine, the "for cause" visits dropped from 1,800 to 38 visits during the following 2 years. In contrast, data from previous non-cyclosporine 0.05% clinical trials involving dry eye patients indicate that 75% of the subjects receiving an active agent felt the same -- or worse -- after the study than in the 12 months preceding it.

Because Cross' study was conducted before Restasis was launched, new studies are needed to confirm the results. However, I've already noticed the same effect on "for cause" visits with my patients. Thanks to the stabilization of their ocular surface, several of my Restasis patients have decreased their office visits from every month or two to twice a year. (Their visits were originally scheduled 3 months apart, but they'd often show up for unscheduled emergency visits.)

In addition, their office visits are now shorter and they leave much happier than they did before they were treated with Restasis.

Fewer related medical costs. In his article, Cross points out: "From an economic perspective dry eye disease is often viewed as having relatively few significant medical costs. However, when use of ancillary medications and more invasive medical treatments (punctal plugs or punctal occlusion) are considered, these costs may rise significantly . . . . Patients with dry eye disease are at greater risk for developing other ophthalmic problems requiring additional medical treatment . . . . Cyclosporine A appears to have potential benefits for health care providers and payers in terms of health care-resource utilization."

Indeed, those benefiting from this economic impact include insurance companies, HMOs, POSs and PPOs. As mentioned earlier, in these trials, insurers ended up paying for only 38 visits after Restasis treatment, instead of 1,800. Also, the large number of indirectly related prescriptions the plans had to pay for decreased dramatically.

Insurance coverage. Insurance coverage, which most of these patients have, makes the cost of Restasis significantly less than retail. My patients' insurers generally charge $30 or less as co-pay for a 1-month supply -- about one dollar a day for a revolutionary new medication.

Less need for artificial tears. Patients won't need to continue buying palliative artificial tears that don't treat the cause of the problem (and aren't covered by insurance). Although artificial tears (e.g., Refresh) can and should be used intermittently with Restasis for additional symptom relief, the FDA clinical studies found that use of supplemental tears gradually wanes as Restasis begins to relieve dry eye symptoms. Many patients eventually stop using them altogether.

Fewer lost work days. Dry eye disease often affects a person's ability to work, so this also factors into the pharmacoeconomic equation. Not only is the condition itself a major source of lost work days, but so are its side-effects and psychological impact. I suspect this new therapy will cause a major reduction in the number of "lost work hours" attributable to dry eye disease.

In addition to these economic considerations, I've found that patients can extend the use of one vial of medication, thereby reducing their costs even further. The packaging says to use two vials a day, but I tell my patients to use one vial a day -- one drop at night and then another in the morning.

I have them store the open vial in the refrigerator (in something that will keep it upright, such as a mug). By using one vial a day, the patient effectively cuts the retail price in half. (I don't advise my patients to use the same vial for longer periods of time because of the risk of contamination.)

At Last: Results

Restasis is good news for our dry eye patients. We now can offer them a solution that will increase the body's ability to produce natural, good quality tears, while quelling the underlying inflammation of dry eye disease.

For the first time we can prescribe a treatment with the knowledge that our patients are likely to return on their follow-up visit happy and satisfied -- and that treatment may actually lighten the economic burden for everyone concerned.

Dr. Donnenfeld practices at the Manhattan Eye, Ear and Throat Hospital. He is also a founding member of Ophthalmic Consultants of Long Island, Rockville Centre, N.Y. He can be contacted at eddoph@aol.com.