1. Lindy Forte, MSc VALORE Research, Toronto, Canada
Economic Evaluation of Loteprednol Etabonate versus Prednisolone in the Treatment of Ocular Inflammation
Lindy Forte, MSc
VALORE Research,
Toronto, Canada
Disclosure: The author has received research funding and travel expense reimbursement from
Bausch and Lomb

2. Introduction
Topical corticosteroids have been the standard of care in the treatment of ocular inflammation.
Side effects of topical corticosteroids include:
increased intraocular pressure (IOP),
risk of cataract formation with long term use, and
decreased resistance to infection.
Loteprednol etabonate is a unique corticosteroid:
quickly metabolized to inactive metabolites
less propensity to cause IOP increase
provides ocular specificity and minimal systemic absorption

3. Study Purpose
To determine the cost-effectiveness of loteprednol etabonate relative to other commonly used steroids in the management of ocular inflammation.

4. Methods
MEDLINE search for studies reporting results of randomized controlled clinical trials:
loteprednol etabonate versus corticosteroid comparators,
conducted in patients having either post-operative inflammation, acute anterior uveitis, giant papillary conjunctivitis, or seasonal allergic conjunctivitis.
Data extraction:
rates of anti-inflammatory efficacy,
proportions of patients with clinically significant intraocular pressure (IOP) elevation.
Perspective:
Healthcare system

5. Methods (con’t) Resource Use and Costing:
resources utilized to manage ocular inflammation and IOP elevation obtained from a panel of five ophthalmologists,
resource costs were collected from the panel and from the U.S. Dept of Veteran’s Affairs formulary.

6. Results Included Studies
Two of 51 publications met the inclusion criteria
Excluded papers:
not RCTS or lacked active corticosteroid comparator
off-label uses
duplicate publications
Novack et al. reported results of a pooled analysis of RCTs (n=1648)
mixed group of patients (n=1648) treated with loteprednol etabonate (0.2% or 0.5%) or prednisolone acetate 1% for 28 days or longer.
Bartlett et al. reported results of a single RCT
Patients (n=19) with a history of corticosteroid responsiveness treated with loteprednol etabonate 0.5% or prednisolone acetate 1%.

7. Results (con’t) Efficacy
Differences between loteprednol etabonate and prednisolone acetate in control of inflammation were not reported
Incidence of clinically significant IOP elevation*
*pooled indication study: IOP ≥ 10 mm Hg; known steroid responder study: IOP > 15 mm Hg

8. Results (con’t) Mixed indication study
Loteprednol saved an average of $8.24 per patient

9. Results (con’t) Known steroid responders study
Loteprednol saved an average of $65.43 per patient

10. Conclusions Mixed indication
Incidence of clinically significant IOP elevation:
Loteprednol 1.7%
Prednisolone 6.7%
Loteprednol saved $8.24 per patient
Known steroid responders
Loteprednol 7.1%
Prednisolone 30.8%
Loteprednol saved $65.43 per patient

11. Discussion
Health system perspective showed that the lower acquisition cost of prednisolone acetate was completely offset by the resources required to manage IOP elevation.
Analysis was somewhat conservative as the potential for IOP elevation to go undetected with serious consequences was not considered.
Results will depend upon local practice patterns and drug costs.