Cost-Utility Analysis of a Medication Adherence-Enhancing Educational Intervention for Glaucoma

Objective: To evaluate the cost utility of a glaucoma medication-enhancing intervention compared to standard of care over a lifetime from the United States Department of Veterans Affairs (VA) payer perspective. Design: Model-based cost-utility analysis of a glaucoma medication-enhancing intervention from a ran-domized clinical trial. Subjects: Veterans with glaucoma, or suspected glaucoma who were prescribed topical glaucoma medi-cations, had their visual field assessed within the last 9 months, and endorsed poor glaucoma medication adherence. Methods: Veterans were randomized either to a behavioral intervention to promote adherence or to a standard of care (control) session about general eye health. A decision analytic model was developed to simulate lifelong costs and quality-adjusted life years (QALYs) for an intervention tested in a randomized clinical trial at a single VA eye clinic. Costs included direct medical costs that the VA payer would incur, as informed initially by the clinical trial and then by published estimates. Health-state quality of life was based on published utility values. Scenario analyses included addition of booster interventions, a 3% decline in chance of staying medication adherent annually, and the combination of the two. Analyses were also conducted in the following subgroups: those with companion versus not, and those with once-daily versus more than once-daily dosing frequency. Main Outcome Measures: Incremental cost-effectiveness ratio (ICER). Results: Compared to standard of care, the intervention dominated resulting in lower costs ($23 339.28 versus $23 504.02) and higher QALYs (11.62 versus 11.58). Among the 4 subgroups, the intervention dominated for 3 of them. In the fourth subgroup, those with more than once-daily dosing, the ICER was $2625/QALY. Compared to standard of care, an intervention with booster interventions led to an ICER of $3278/QALY. Assuming both a 3% annual loss in chance of continuing to be adherent and addition of booster interventions, the ICER increased to $71 371/QALY. Conclusions: From a VA payer perspective over a lifetime, the glaucoma medication-enhancing behavioral intervention dominated standard of care in terms of generating cost savings and greater QALYs. Financial Disclosures: Proprietary or commercial disclosure may be found after the references. Ophthalmology Glaucoma 2023;6:395-404 Published by Elsevier Inc. on behalf of the American Academy of Ophthalmology