Use of managed care claims data to validate a pharmacoeconomic model of Ophthalmic Steroid treatment

Purpose. To compare treatment patterns and costs for ophthalmic inflammatory conditions in a managed care organization with a previously-developed physician-based pharmacoeconomic model, the Ophthalmic Steroid Model. A secondary objective was to evaluate the projected economic impact of use of the ophthalmic steroid rimexolone (Vexol®) compared to alternative ophthalmic steroids using both data sources. Design. Managed care data evaluated by retrospective analysis of electronic claims records from January 1, 1992 through December 31, 1995 from a group-model health maintenance organization in New Mexico. Methodology. Computerized medical and pharmacy claims data were analyzed for all eligible patients treated for uveitis, post-cataract surgery, and other ophthalmic inflammatory conditions with the use of ophthalmic steroids. Treatment patterns and medical resource utilization were stratified based on development of elevated intraocular pressure (IOP). Results were then compared to the previously-developed Ophthalmic Steroid Model based on estimates from a physician panel and published literature. Principal Findings. The incidence of steroid-induced IOP elevation in the managed care population was similar to that provided by the physician panel. However, the rates of physician visits and diagnostic tests for IOP elevation and associated treatment costs were higher in the claims data analysis than those indicated by the physician panel. Use of rimexolone was projected to result in cost savings in both the claims data analysis and the Ophthalmic Steroid Model, but greater savings were projected from the claims data analysis. Conclusions. The managed care claims data analysis validated the physician panel-derived Ophthalmic Steroid Model, indicating similar incidence and treatment patterns for steroid-induced IOP elevation. However, the Ophthalmic Steroid Model underestimated the costs associated with IOP elevation and provided conservative estimates of the savings resulting from rimexolone use as compared to the claims data analysis.