Patient Preference and Adherence (Aug 2022)
Clinical Practice Management of Primary Open-Angle Glaucoma in the United States: An Analysis of Real-World Evidence
Abstract
Joseph S Imperato,1 Kelly H Zou,1 Jim Z Li,1 Tarek A Hassan2 1Global Medical Analytics and Real-World Evidence, Viatris Inc., Canonsburg, PA, USA; 2Global Medical Affairs, Ophthalmology, Viatris Inc, Canonsburg, PA, USACorrespondence: Tarek A Hassan, Global Medical Affairs, Ophthalmology, Viatris Inc, 1000 Mylan Boulevard, Canonsburg, PA, 15317, USA, Tel +1 347 443 2850, Email [email protected]: To investigate clinical management of primary open-angle glaucoma (POAG) in the United States using real-world evidence and to examine healthcare resource utilization (HCRU), medication adherence/persistence, and procedure use.Design: A cross-sectional, retrospective analysis of Optum’s de-identified Market Clarity Dataset (July 1, 2013–December 31, 2019).Patients and Methods: Patients ≥ 18 years with POAG diagnosis and continuous enrollment for 1-year pre- and post-index were eligible and categorized into four mutually exclusive cohorts: CH1, treated with antiglaucoma medication(s) only; CH2, underwent glaucoma procedure(s) only; CH3, treated with antiglaucoma medication(s) and underwent procedure(s); and CH4, received no treatment for POAG. Adherence and persistence with antiglaucoma medications, and disease-specific HCRU were analyzed. Pairwise two-sample comparisons and multivariate regressions were conducted.Results: Examined 232,572 eligible patients (CH1=60,895; CH2=4330; CH3=6027; CH4=161,320). Prostaglandin analogs were most prescribed antiglaucoma medications (CH1: 69.7%; CH3: 62.7%), of which latanoprost was most common (CH1: 51.3%; CH3: 46.1%). Disease-specific office visits occurred in 26.3%, 78.2%, 75.0%, 23.8%, and surgical services visits occurred in 3.8%, 36.3%, 42.5%, 3.3%, in CH1-CH4, respectively. Adherence was higher (medication possession ratio: 47.1% vs 39.4%; P< 0.0001), and more patients remained persistent across 1-year post-index period in CH1 vs CH3 (25.4% vs 16.1%; P< 0.0001). Positive predictors of medication persistence included being female, ≥ 55 years, and history of dyslipidemia or thyroid disease (all P≤ 0.0003).Conclusion: Overall, 70% POAG patients might not have received antiglaucoma treatment. Since POAG is a slowly progressive blinding disease, the lack of antiglaucoma treatment and suboptimal adherence/persistence with medications are of major concerns. Targeted screening and educational approaches are needed to improve POAG management.Keywords: adherence, antiglaucoma, health care resource utilization, persistence, real-world evidence
