Análise de custo-utilidade do colírio latanoprosteno bunode no tratamento do glaucoma primário de ângulo aberto sob a perspectiva do Sistema Único de Saúde

Abstract

Glaucoma is a progressive optic neuropathy that impairs visual function and quality of life, and is the leading cause of irreversible blindness worldwide. The Brazilian Unified Health System (Sistema Único de Saúde – SUS) guarantees universal access to pharmacological, surgical, and laser treatments for the disease, offering these services free of charge as part of its public health policy. New pharmacological therapies have become available on the market, such as latanoprostene bunod (LBN) 0.024% eye drops, which have demonstrated greater efficacy in reducing intraocular pressure compared to latanoprost. However, LBN has not yet been assessed for incorporation into the Brazilian health system. This study aims to assess the incremental cost-utility ratio (ICUR) of LBN 0.024% as a first-line treatment for primary open-angle glaucoma (POAG), compared to the current standard recommended by the Clinical Protocol and Therapeutic Guidelines (PCDT) of SUS. A cost‑utility analysis was conducted using a hypothetical cohort and a Markov model. The budgetary perspective adopted was that of the Brazilian Unified Health System (SUS), with a time horizon beginning at age 60 and extending to the average life expectancy of the Brazilian population. In the base‑ case scenario, we adopted the strategy recommended by the PCDT for glaucoma, assuming initiation of treatment with timolol 0.05%. In the event of failure to reach the target intraocular pressure, dorzolamide 2% and a prostaglandin analogue were added sequentially. The comparator scenario considered using LBN 0.024% eye drops as the first therapeutic option, followed by combinations of timolol 0.05% and dorzolamide 2% as needed. After model simulation, the incremental cost‑utility ratio (ICUR) was BRL 31,244.98 per QALY for the strategy starting with LBN 0.024%, compared with the SUS strategy. Entry age (40 or 70 years) in the model was the parameter that had the greatest impact on the ICUR, resulting in costs of BRL 24,953.82 and BRL 50,284.30 per QALY, respectively. Based on the recommended cost‑effectiveness threshold of up to one GDP per capita (gross domestic product per capita, GDP), which is BRL 55,247.45 for 2024 according to the Brazilian Institute of Geography and Statistics, we conclude that the incorporation of LBN 0.024% as a first‑line medication in the clinical treatment of primary open‑angle glaucoma is cost‑effective from the SUS perspective.