Implementing an adherence-enhancing behavioral intervention that uses a combination of a counseling session and smart bottles that remind patients to take their medication improves compliance in patients with glaucoma, according to research published in the American Journal of Ophthalmology. The method is cost-effective and those with companions to assist them with medication dosing experience the greatest cost savings, according to the report.
Researchers enrolled 192 participants (94% men; 73% Black; mean glaucoma medications, 1.8) with glaucoma and self-reported poor adherence from a Veterinary Affairs (VA) eye clinic. Patients were randomly assigned to a treatment group (n=95) consisting of a 45 minute educational session and a smart bottle that issued reminders for patients to take their medication or a control group (n=97). Control group individuals attended an educational session on general eye health and received smart bottles, but the bottles did not issue reminders for them to take their medications. Costs were assessed from the perspective of the VA payor, and included spending associated with training, VA salaries, the smart bottle, and care-related costs.
The report shows a higher proportion of adherent patients in the treatment group compared with the control group (0.78 vs 0.40; P <.0001) and a higher proportion of doses taken on time (0.85 vs 0.62; P <.001).
Overall, 6-month VA costs were lower among individuals in the intervention group compared with control individuals ($1,149,600 vs $1,298,700). Labor and educational training costs were not significantly different between the cohorts. Smart bottle costs per patient were higher for individuals in the intervention group compared with control group participants ($549 vs $48). Glaucoma-related costs per patient, however, were higher among control group participants compared with those in the treatment group ($1699 vs $432). Researchers estimate a savings of $149,100 using the treatment strategy.
The study authors stress that “adherence is an important outcome metric from the perspective of the payor. Nonadherence leads to unnecessary healthcare spending, and investment by the payor to improve adherence could therefore reduce overall costs.”
Study limitations include the strict inclusion of veterans, an overrepresentation of men in the study sample, and differences in costs between third party payors and the VA payor.
Williams AM, Theophanous C, Muir KW. Within-trial cost-effectiveness of an adherence-enhancing educational intervention for glaucoma. Am J Ophthalmol. Published online August 21, 2022. doi:10.1016/j.ajo.2022.08.011