Study on Incentives for Glaucoma Medications Adherence

NCT02271269 | Completed

• 1 other identifier: HSRNIG12nov007
• Study Type: interventional
• Target: 100
• Locations: 1 country
• Sites: 1

Brief Summary

Glaucoma topical eye medications, when adhered to, are effective at controlling disease progression. Yet evidence shows that many glaucoma patients have incomplete adherence to medications, with disease progression resulting in significant costs to the patient and health system. Through the approach of value pricing, a link can be made between non-adherence and its resulting costs by granting subsidies to adherent patients for their medications and physician visits. This 6-month randomized controlled trial among 100 glaucoma patients from the Singapore National Eye Centre aims to test the extent to which value pricing can improve medication adherence.

Conditions

Glaucoma

Keywords

glaucoma; medication adherence; financial incentives; behavioral economics

Outcome Measures

Primary Outcomes (1)

• Monthly dose-rate adherence percentage

  The proportion of days across a month where a patient took all medication(s) within the appropriate dosing windows (morning, afternoon, evening) for the day.

  Month 6

Secondary Outcomes (6)

• Dose-rate adherence percentage

  Months 1 - 6

• Proportion meeting 90% dose-rate adherence percentage

  Months 3 & 6

• Proportion meeting 75% dose-rate adherence percentage

  Months 3 & 6

• Intraocular Pressure

  Baseline & Month 6

• EQ-5D-5L

  Baseline & Month 6

Study Arms (2)

Usual Care (UC)

NO INTERVENTION

Patients receiving Usual Care for Glaucoma comprising: * Education on effective glaucoma treatment * Routine check-ups with an ophthalmologist and prescription of glaucoma eye drops * Glaucoma counselling \[Can be recommended by ophthalmologist for non-adherent patients\] covering: * Glaucoma risk factors and symptoms * Management and treatment * Medications and optimal dosage windows * Risks of medication non-adherence * Formulation of a dosing schedule that compliments each patient's lifestyle

Value Pricing (VP)

EXPERIMENTAL

Patient receiving Usual Care for Glaucoma and given the opportunity to receive Value Pricing Subsidies.

Behavioral: Value Pricing Subsidies

Interventions

Value Pricing Subsidies BEHAVIORAL

* Usual care for glaucoma * Subsidies granted to adherent patients for their glaucoma medications and physician visits, lowering the costs of treatment and providing a financial incentive for patients to take their medicines as prescribed. * Subsidy (25 / 50%) granted based on meeting dose-rate adherence percentage targets (75 / 90%) at the month 3 and 6 assessment points.

Value Pricing (VP)

Eligibility Criteria

• Age: 21 Years - 85 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Singaporean citizens or permanent residents
• Conversant in English or Mandarin
• Taking at least one glaucoma eye drop medication
• Shown to be non-adherent based on a value of 6 or less on the Modified Medication Adherence Scale (MMAS)

You may not qualify if:

• Significant comorbid conditions preventing application of medications without assistance
• Stage 4 (advanced) or Stage 5 (end stage) glaucoma according to the Glaucoma Staging System

Sponsors & Collaborators

• Duke-NUS Graduate Medical School: lead
• Singapore National Eye Centre: collaborator

Study Sites (1)

Singapore National Eye Center

Singapore, Singapore

Location

Related Publications (13)

• Elliott RA, Shinogle JA, Peele P, Bhosle M, Hughes DA. Understanding medication compliance and persistence from an economics perspective. Value Health. 2008 Jul-Aug;11(4):600-10. doi: 10.1111/j.1524-4733.2007.00304.x. Epub 2008 Jan 8.

  PMID: 18194403 BACKGROUND

• Chapman GB, Brewer NT, Coups EJ, Brownlee S, Leventhal H, Leventhal EA. Value for the future and preventive health behavior. J Exp Psychol Appl. 2001 Sep;7(3):235-50.

  PMID: 11676102 BACKGROUND

• van Dulmen S, Sluijs E, van Dijk L, de Ridder D, Heerdink R, Bensing J. Patient adherence to medical treatment: a review of reviews. BMC Health Serv Res. 2007 Apr 17;7:55. doi: 10.1186/1472-6963-7-55.

  PMID: 17439645 BACKGROUND

• Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD000011. doi: 10.1002/14651858.CD000011.pub3.

  PMID: 18425859 BACKGROUND

• Giuffrida A, Torgerson DJ. Should we pay the patient? Review of financial incentives to enhance patient compliance. BMJ. 1997 Sep 20;315(7110):703-7. doi: 10.1136/bmj.315.7110.703.

  PMID: 9314754 BACKGROUND

• DiMatteo MR. Variations in patients' adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004 Mar;42(3):200-9. doi: 10.1097/01.mlr.0000114908.90348.f9.

  PMID: 15076819 BACKGROUND

• Volpp KG, Loewenstein G, Troxel AB, Doshi J, Price M, Laskin M, Kimmel SE. A test of financial incentives to improve warfarin adherence. BMC Health Serv Res. 2008 Dec 23;8:272. doi: 10.1186/1472-6963-8-272.

  PMID: 19102784 BACKGROUND

• Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008 May;10(5):348-54. doi: 10.1111/j.1751-7176.2008.07572.x.

  PMID: 18453793 BACKGROUND

• Mills RP, Budenz DL, Lee PP, Noecker RJ, Walt JG, Siegartel LR, Evans SJ, Doyle JJ. Categorizing the stage of glaucoma from pre-diagnosis to end-stage disease. Am J Ophthalmol. 2006 Jan;141(1):24-30. doi: 10.1016/j.ajo.2005.07.044.

  PMID: 16386972 BACKGROUND

• Horne R, Weinman J. Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res. 1999 Dec;47(6):555-67. doi: 10.1016/s0022-3999(99)00057-4.

  PMID: 10661603 BACKGROUND

• Tsai JC, McClure CA, Ramos SE, Schlundt DG, Pichert JW. Compliance barriers in glaucoma: a systematic classification. J Glaucoma. 2003 Oct;12(5):393-8. doi: 10.1097/00061198-200310000-00001.

  PMID: 14520147 BACKGROUND

• Bilger M, Wong TT, Lee JY, Howard KL, Bundoc FG, Lamoureux EL, Finkelstein EA. Using Adherence-Contingent Rebates on Chronic Disease Treatment Costs to Promote Medication Adherence: Results from a Randomized Controlled Trial. Appl Health Econ Health Policy. 2019 Dec;17(6):841-855. doi: 10.1007/s40258-019-00497-0.

  PMID: 31317511 DERIVED

• Bilger M, Wong TT, Howard KL, Lee JY, Toh AN, John G, Lamoureux EL, Finkelstein EA. Study on Incentives for Glaucoma Medication Adherence (SIGMA): study protocol for a randomized controlled trial to increase glaucoma medication adherence using value pricing. Trials. 2016 Jul 15;17(1):316. doi: 10.1186/s13063-016-1459-1.

  PMID: 27422389 DERIVED

MeSH Terms

Conditions

Glaucoma; Medication Adherence

Condition Hierarchy (Ancestors)

Ocular Hypertension; Eye Diseases; Patient Compliance; Patient Acceptance of Health Care; Treatment Adherence and Compliance; Health Behavior; Behavior

Study Officials

• Marcel Bilger, PhD

  Duke-NUS Graduate Medical School

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: October 19, 2014
• First Posted: October 22, 2014
• Study Start: November 1, 2014
• Primary Completion: January 1, 2017
• Study Completion: February 1, 2017
• Last Updated: May 1, 2017

Record last verified: 2017-04

Locations

SG (1)