OBJECTIVES : Netarsudil and recently approved fixed dose combination (FDC) Netarsudil/Latanoprost have shown significant effect of lowering intra-ocular pressure in glaucoma comparable to most widely used prostaglandin analog, Latanoprost. This research aims to assess the cost-effectiveness of FDC Netarsudil/Latanoprost, monotherapy Netarsudil 0.02% and monotherapy Latanoprost 0.005% in reducing intra-ocular pressure (IOP).

METHODS : Clinical data was directly extracted from the MERCURY-1 trial. The primary outcome measure of this study was the mean IOP reduction effect in mmHg. Costs were assessed from the perspective of US healthcare system with a 3 months’ time horizon. A decision tree model was constructed comparing treatment groups. Incremental cost effectiveness ratio was compared to an informal willingness to pay of $2,500 per mmHg reduction in IOP.

RESULTS : In the Netarsudil/Latanoprost treatment group, the mean reduction in IOP from baseline to final visit was 8.2 mmHg, whereas only 5.5 mmHg in Netarsudil group and 6.4 mmHg in Latanoprost group. The direct medical cost per patient were $1673.61, $1654.73 and $1570.83 for Netarsudil/Latanoprost, Netarsudil and Latanoprost respectively. Netarsudil was dominated due to its high cost and low efficacy. In the cost effectiveness analysis, incremental cost of $102.78, incremental effectiveness of 2.23 mmHg reduction in IOP with an incremental cost effectiveness ratio of $46.17 per mmHg reduction in IOP were obtained for Netarsudil/Latanoprost over Latanoprost monotherapy. At an informal willingness to pay value set at $2,500, Netarsudil/Latanoprost is more cost effective than Latanoprost monotherapy. A one way sensitivity analysis, conducted by changing the values of the effectiveness, produced the same results.

CONCLUSIONS : Considering the direct medical cost of treatment option and the assumption of clinical success at 3 months decision point, Netarsudil/Latanoprost demonstrated superior efficacy profile and was found to be most cost-effective medication among the three treatment groups compared.