Study on Incentives for Glaucoma Medications Adherence
Condition: Glaucoma
MeSH terms: Glaucoma
Study type: Interventional

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.
    

Detailed description: 
      By reducing intraocular pressure, glaucoma topical eye medications are effective at
      controlling disease progression for the majority of patients. Yet evidence shows that many
      glaucoma patients have incomplete adherence to medications, resulting in significant personal
      costs in terms of disease progression and visual field loss. The cost to the health system
      from poor adherence is also substantial as glaucoma surgery is more costly than treatment
      with topical medication. Behavioural economics theory suggests that adherence rates can be
      improved by providing a clearer link between non-adherence and the resulting costs thereof.
      In the proposed study, this link is made by granting subsidies to adherent patients for their
      medications and physician visits, whereas those who are not sufficiently adherent would not
      receive the subsidy and thus pay a higher rate for their treatment.

      These subsidies provide a financial incentive for patients to take their medicines as
      prescribed, and because prescription refills and visits occur regularly, also provide a
      tangible and near-term cost resulting from non-adherence. The investigators refer to this
      approach as value pricing as subsidies are allocated to medications that have not only been
      shown to be clinically effective but that are also effectively used by the patient. In
      efforts to increase adherence among glaucoma patients in Singapore, the investigators propose
      to conduct a 6-month proof-of-concept randomized controlled trial among 100 participants from
      the Singapore National Eye Centre (SNEC) to test the extent to which value pricing can
      improve medication adherence. As Singapore's population continues to age and a larger share
      of the population requires daily medications to treat chronic diseases, such innovative
      solutions are needed to ensure not only that patients take their medications as prescribed
      and receive the full benefit of their treatment but also that Government subsidies are
      allocated effectively so that to ensure the sustainability of the health system.

      Specific Aim and hypothesis tested:

      Aim: Test whether adding Value Pricing (VP) to Usual Care (UC) can improve medication
      adherence over a 6-month period.

      Hypothesis: VP patients will show greater adherence rates at 6 months compared to those
      receiving only UC.
    

Intervention name(s): Value Pricing Subsidies
Intervention type(s): Behavioral
Intervention description(s): 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.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: glaucoma; medication adherence; financial incentives; behavioral economics