Ocular surface disease and glaucoma

A Cost-Utility Analysis of Trabecular Bypass Devices Versus Usual Care for Patients With Open-Angle Glaucoma

OBJECTIVE

The aim of this study was to determine whether insertion of a trabecular bypass device (TBD) is a cost-effective intervention for the treatment of open-angle glaucoma (OAG) with mild to moderate vision loss in the Australian setting.

METHODS

We performed a cost-utility analysis of TBD implantation in conjunction with cataract surgery or as a standalone procedure in patients with OAG. The model used a Monte Carlo simulation to follow individual patients through a glaucoma treatment algorithm that included TBD and compared the costs and outcomes with those of patients simulated through an algorithm without TBD (usual care). The model tracked the intraocular pressure (IOP) of individual patients and then, based on this IOP, tracked the progression of the patient's glaucoma. Utility values were assigned dependent on severity of glaucoma. The analysis took the perspective of the Australian health care system. The main outcome was incremental cost per quality-adjusted life-year (QALY) of TBD versus usual care for the treatment of OAG.

RESULTS

In the cataract surgery population, TBD surgery was associated with incremental healthcare costs of A$177 and 0.0726 QALYs per patient, resulting in an incremental cost per QALY gained of A$2430. In the standalone population, the overall incremental cost of TBD surgery versus usual care was A$2234. With QALYs gained of 0.1526 per patient, this equated to an incremental cost per QALY gained ratio of A$14,644.

CONCLUSION

The incremental cost per QALY estimates for TBD were below thresholds generally accepted by Australian healthcare payers, suggesting that TBD is a cost-effective intervention for patients with primary OAG in the Australian setting.

Enhanced Corneal Penetration of a Poorly Permeable Drug Using Bioadhesive Multiple Microemulsion Technology

Corneal penetration is a key rate limiting step in the bioavailability of topical ophthalmic formulations that incorporate poorly permeable drugs. Recent advances have greatly aided the ocular delivery of such drugs using colloidal drug delivery systems. Ribavirin, a poorly permeable BCS class-III drug, was incorporated in bioadhesive multiple W/O/W microemulsion (ME) to improve its corneal permeability. The drug-loaded ME was evaluated regarding its physical stability, droplet size, PDI, zeta potential, ultrastructure, viscosity, bioadhesion, in vitro release, transcorneal permeability, cytotoxicity, safety and ocular tolerance. Our ME possessed excellent physical stability, as it successfully passed several cycles of centrifugation and freeze-thaw tests. The formulation has a transparent appearance due to its tiny droplet size (10 nm). TEM confirmed ME droplet size and revealed its multilayered structure. In spite of the high aqueous solubility and the low permeability of ribavirin, this unique formulation was capable of sustaining its release for up to 24 h and improving its corneal permeability by 3-fold. The in vitro safety of our ME was proved by its high percentage cell viability, while its in vivo safety was confirmed by the absence of any sign of toxicity or irritation after either a single dose or 14 days of daily dosing. Our ME could serve as a vehicle for enhanced ocular delivery of drugs with different physicochemical properties, including those with low permeability.

Development and characterisation of electrospun timolol maleate-loaded polymeric contact lens coatings containing various permeation enhancers

Despite exponential growth in research relating to sustained and controlled ocular drug delivery, anatomical and chemical barriers of the eye still pose formulation challenges. Nanotechnology integration into the pharmaceutical industry has aided efforts in potential ocular drug device development. Here, the integration and in vitro effect of four different permeation enhancers (PEs) on the release of anti-glaucoma drug timolol maleate (TM) from polymeric nanofiber formulations is explored. Electrohydrodynamic (EHD) engineering, more specifically electrospinning, was used to engineer nanofibers (NFs) which coated the exterior of contact lenses. Parameters used for engineering included flow rates ranging from 8 to 15μL/min and a novel EHD deposition system was used; capable of hosting four lenses, masked template and a ground electrode to direct charged atomised structures. SEM analysis of the electrospun structures confirmed the presence of smooth nano-fibers; whilst thermal analysis confirmed the stability of all formulations. In vitro release studies demonstrated a triphasic release; initial burst release with two subsequent sustained release phases with most of the drug being released after 24h (86.7%) Biological evaluation studies confirmed the tolerability of all formulations tested with release kinetics modelling results showing drug release was via quasi-Fickian or Fickian diffusion. There were evident differences (p<0.05) in TM release dependant on permeation enhancer.