Within-Trial Cost-Effectiveness of an Adherence-Enhancing Educational Intervention for Glaucoma.
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2022-12
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Abstract
Purpose
To assess the within-trial cost-effectiveness of a behavioral intervention to improve glaucoma medication adherence.Design
Prospective cost-effectiveness analysis of randomized, controlled trial data.Methods
The study setting was a Veterans Affairs (VA) eye clinic. The patient population comprised veterans with medically treated glaucoma and self-reported poor adherence. Participants were randomized to a personalized educational session with a reminder bottle to promote medication adherence or to a control session on general eye health. Costs were assessed from the perspective of the VA payor at 6 months using the VA Managerial Cost Accounting System. Probabilistic sensitivity analyses were conducted using bootstrapped samples. The main outcome measures were the proportion of participants attaining ≥80% adherence as measured by electronic monitor, total intervention and medical resource costs, and incremental cost-effectiveness ratios comparing intervention to control at 6 months.Results
Of 200 randomized participants, 95 of 100 assigned to the intervention and 97 of 100 assigned to the control had adherence outcomes at 6 months, and the proportion of adherent patients was higher in the intervention group compared to control (0.78 vs 0.40, P < .0001). All participants had costs at 6 months. The total cost at 6 months was $1,149,600 in the intervention group (n = 100) compared to $1,298,700 in the control group (n = 100). Thus, in a hypothetical cohort of 100 patients, the intervention was associated with cost savings (-$149,100) and resulted in 38 additional patients achieving medication adherence.Conclusions
An adherence-enhancing behavioral intervention was effective and cost saving at 6 months.Type
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Williams, Andrew M, Christos Theophanous, Kelly W Muir, Jullia A Rosdahl, Sandra Woolson, Maren Olsen, Hayden B Bosworth, Anna Hung, et al. (2022). Within-Trial Cost-Effectiveness of an Adherence-Enhancing Educational Intervention for Glaucoma. American journal of ophthalmology, 244. pp. 216–227. 10.1016/j.ajo.2022.08.011 Retrieved from https://hdl.handle.net/10161/29619.
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Kelly Walton Muir
Kelly W. Muir, MD, specializes in the medical and surgical management of glaucoma, cataracts and general eye disease. Her research focuses on optimizing the quality of care that glaucoma patients receive by improving patient education materials, studying patient and physician communication, and developing a novel eye drop bottle that makes it easier for patients to administer their glaucoma drops. Her research has been funded by the American Glaucoma Society, the National Eye Institute, and the Veterans Health Administration. Dr. Muir also teaches medical students, residents, and fellows about glaucoma and other ophthalmologic conditions. Dr. Muir is fellowship-trained, board-certified and a member of the American Academy of Ophthalmology and American Glaucoma Society.
Jullia Ann Rosdahl
I am a glaucoma specialist at the Duke Eye Center.
My passions are teaching, caring for patients and doctors, and saving retinal ganglion cells.
My research interests include patient education and adherence, medical and surgical education, OCT imaging for glaucoma, and physician wellness.
Maren Karine Olsen
Health services research, longitudinal data methods, missing data methods
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