Within-Trial Cost-Effectiveness of an Adherence-Enhancing Educational Intervention for Glaucoma

center dot PURPOSE: To assess the within-trial cost-effectiveness of a behavioral intervention to improve glaucoma medication adherence. center dot DESIGN: Prospective cost-effectiveness analysis of ran-domized, controlled trial data.center dot METHODS: The study setting was a Veterans Affairs (VA) eye clinic. The patient population comprised vet-erans with medically treated glaucoma and self-reported poor adherence. Participants were randomized to a per-sonalized educational session with a reminder bottle to promote medication adherence or to a control session on general eye health. Costs were assessed from the perspec-tive of the VA payor at 6 months using the VA Managerial Cost Accounting System. Probabilistic sensitivity analy-ses were conducted using bootstrapped samples. The main outcome measures were the proportion of participants at-taining >= 80% adherence as measured by electronic mon-itor, total intervention and medical resource costs, and incremental cost-effectiveness ratios comparing interven-tion to control at 6 months.center dot 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 inter-vention group compared to control (0.78 vs 0.40, P < .0001). All participants had costs at 6 months. The to-tal 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 sav-ings (-$149,100) and resulted in 38 additional patients achieving medication adherence.center dot CONCLUSIONS: An adherence-enhancing behavioral intervention was effective and cost saving at 6 months. (Am J Ophthalmol 2022;244: 216-227. (c) 2022 Else-vier Inc. All rights reserved.)