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Ocular lubricants: Utilisation analysis using PBS data

Page last updated: 13 July 2021

Drug utilisation sub-committee (DUSC)

February 2021

Abstract

Purpose

PBAC requested a review of the utilisation of ocular lubricants at its July 2020 meeting.

Data Source / methodology

Data for all ocular lubricants listed on the PBS were extracted from the Services Australia PBS supplied prescriptions database for the 7 years from January 2013 to December 2019.

Key Findings

  • In 2019, there were 1.86 million ocular lubricant prescriptions dispensed on the PBS. These included 1.10 million multidose preservative containing (PC) ocular lubricant prescriptions, 445,386 single dose preservative free (PF) prescriptions and 312,139 multidose PF prescriptions.
  • Since 2013, the number of ocular lubricants prescriptions dispensed on the PBS has fallen by 7.9%. This is due to a 32.7% fall in the number of prescriptions for PC formulations, largely offset by a corresponding 1573% increase in multidose PF ocular lubricant prescription numbers and a 22.0% increase in single dose PF ocular lubricant prescription numbers.
  • The increase in multidose PF ocular lubricant prescription numbers is almost entirely attributable to increasing use of multidose PF sodium hyaluronate (Hylo-Fresh or Hylo-Forte). It increased 2197% from 11,831 prescriptions in 2013 to 271,709 prescriptions in 2019 and dispensing continues to grow. In contrast, the most commonly dispensed ocular lubricant in 2019 – the multidose PC ocular lubricant polyethylene glycol-400 + propylene glycol (Systane) – fell from 457,548 prescriptions in 2013 to 359,973 prescriptions in 2019.
  • In 2019, the cost to government for all ocular lubricants was $31.6 million, an increase of $9.2 million (40.9%) when compared to expenditure on all ocular lubricants in 2013. This has been driven almost entirely by an $8.3 million (1622%) increase in expenditure on the multidose PF ocular formulations.
  • In 2019, multidose PF sodium hyaluronate accounted for 14.6% of all dispensed ocular lubricant prescriptions. Expenditure on multidose PF sodium hyaluronate alone cost $7.70 million, accounting for 37.1% of PBS expenditure on all PF ocular lubricants and 24.3% of PBS expenditure on all ocular lubricants.
  • Approximately 80% of dispensed prescriptions for any type of ocular lubricant were prescribed by GPs. Ophthalmologists accounted for another 15.0–19.2% of prescriptions and optometrists 1.2–3.3% of prescriptions each year.
  • Concessional prescriptions account for approximately 90% of all ocular lubricant prescriptions, regardless of formulation type. General (including RPBS) prescriptions accounted for 7.5% of the entire market in 2019 and 2.8% under co-payment.
  • Approximately 407,000 patients had an ocular lubricant dispensed at least once in 2019. This included ~262,000 patients who were dispensed a multidose PC ocular lubricant, ~132,000 dispensed a single dose PF ocular lubricant and ~83,000 dispensed a multidose PF ocular lubricant. Patients could have had more than one type of ocular lubricant dispensed during the year.
  • Between 2013 and 2019 there has been a 4.8% reduction in the number of unique patients who had an ocular lubricant dispensed. Since 2013, the number of unique patients who were dispensed a PC ocular lubricant at least once during a calendar year has decreased by 32.2% but the number of unique patients who were dispensed a single or multidose PF ocular lubricant has increased by 24.7% and 1097%, respectively.
  • The majority of patients who were dispensed at least one ocular lubricant were aged 65+ years (81.8%). Two thirds of patients were women.
  • The largest rises in multidose PF multidose ocular lubricant use were seen in men and women aged 65+ years. However, there has also been an 857% increase in the numbers of men aged 45–64 years and a 772% increase in the numbers of women aged 45–64 years who were dispensed a multidose PF ocular lubricant at least once over the study period.
  • The number of patients started on an ocular lubricant for the first time (direct initiation) each calendar year has fallen from 165,789 in 2014 to 114,660 in 2019 (30.8% decrease). However, while the number of patients being started on a PC ocular lubricant halved over the study period, the number of patients started on a PF multidose ocular lubricant increased 508%.
  • The increase in the use of PF ocular lubricants seems to be due to more patients starting on these formulations without any record of trialling a PC ocular lubricant. In 2019, ~80% of patients started on a PF ocular lubricant appear to have been directly initiated on a PF ocular lubricant. While the reason for this cannot be established using PBS data it could reflect:
    • previous use of over-the-counter or private PC or PF ocular lubricants before a patient is dispensed their first PBS prescription;
    • a clinical preference for PF ocular lubricants given difficulties in clearly classifying symptom severity, limited PBS guidance as to what constitutes severe dry eye syndrome, and guidance that states that PF formulations are preferred for patients with severe dry eye syndrome.
  • While the number of patients directly started on a PF ocular lubricant is increasing, among patients started on a PC ocular lubricant, 90% have no record of being switched to a PF ocular lubricant.

Full Report

Note: An analysis on the utilisation of ocular lubricants for dry eye syndrome was also done using MedicineInsight data and is available here.