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Abstract #105016 Published in IGR 23-2
Within-Trial Cost-Effectiveness of an Adherence-Enhancing Educational Intervention for Glaucoma
Williams AM; Theophanous C; Muir KW; Rosdahl JA; Woolson S; Olsen M; Bosworth HB; Hung AAmerican Journal of Ophthalmology 2022; 244: 216-227
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.
From the Department of Ophthalmology (A.M.W., C.T., K.W.M., J.A.R., H.B.B.), Duke University School of Medicine, Durham, North Carolina, USA; Department of Ophthalmology (A.M.W.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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