Ophthalmic Medication Expenditures and Out-of-Pocket Spending

Chen, Evan M.; Kombo, Ninani; Teng, Christopher C.; Mruthyunjaya, Prithvi; Nwanyanwu, Kristen; Parikh, Ravi

doi:10.1016/j.ophtha.2020.04.037

Cited by 25 publications

(20 citation statements)

References 29 publications

(35 reference statements)

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“…25 Offering lower-cost options to all patients is critical because many patients do not discuss cost concerns with their physicians, 26 even as national expenditures for ophthalmic medications continue to rise. 27 This is evident in our study results; although only 195 non-Hispanic White individuals (6.8%) reported not being able to afford medications, 556 (19.3%) asked for lower-cost medications. In contrast, a much higher percentage of non-Hispanic African American individuals reported not being able to afford medications (91 [18.9%]), and a lower percentage asked for lower cost medications (79 [16.4%]) (Table 1).…”

Section: Discussionmentioning

confidence: 52%

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Racial and Ethnic Disparities in Cost-Related Barriers to Medication Adherence Among Patients With Glaucoma Enrolled in the National Institutes of Health All of Us Research Program

et al. 2022

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IMPORTANCE Ability to afford medication is a major determinate of medication adherence among patients.OBJECTIVE To determine cost-related barriers to medication adherence by race and ethnicity in a nationwide cohort of patients with glaucoma. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study included patients with glaucoma enrolled in the National Institutes of Health All of Us Research Program, a nationwide longitudinal cohort of US adults, with more than 300 000 currently enrolled. Individuals with a diagnosis of glaucoma based on electronic health record diagnosis codes who participated in the Health Care Access and Utilization survey and had complete data on all covariates were studied. Data were collected from June 2016 to March 2021, and data were analyzed from August to November 2021.EXPOSURES Race and ethnicity defined as non-Hispanic African American, non-Hispanic Asian, Hispanic, and non-Hispanic White.MAIN OUTCOMES AND MEASURES Logistic regression was used to evaluate the association between reported cost-related barriers to medication adherence (could not afford prescription medication, skipped medication doses to save money, took less medication to save money, delayed filling a prescription to save money, asked for lower-cost medication to save money, bought prescriptions from another country to save money, and used alternative therapies to save money) and race and ethnicity, adjusting multivariable models by age, gender, health insurance status, education, and income. Odds ratios of these barriers were obtained by race and ethnicity, with non-Hispanic White race as the reference group. RESULTSOf 3826 included patients with glaucoma, 481 (12.6%) were African American, 119 (3.1%) were non-Hispanic Asian, 351 (9.2%) were Hispanic, and 2875 (75.1%) were non-Hispanic White. The median (IQR) age was 69 (60-75) years, and 2307 (60.3%) were female. After adjusting for confounders, non-Hispanic African American individuals (odds ratio, 1.82; 95% CI, 1.34-2.44) and Hispanic individuals (odds ratio, 1.77; 95% CI, 1.25-2.49) were more likely than non-Hispanic White individuals to report not being able to afford medications. Further, despite having the lowest rate of endorsing difficulty affording medications, non-Hispanic White individuals were equally likely to ask for lower-cost medication from their clinicians as individuals of racial and ethnic minority groups.CONCLUSIONS AND RELEVANCE In this study, there was significantly higher odds of self-reported difficulty affording medications among non-Hispanic African American and Hispanic individuals compared with non-Hispanic White individuals. Clinicians should be proactive and initiate discussions about costs in an effort to promote medication adherence and health equity among patients.

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Section: Discussionmentioning

confidence: 52%

“…This has contributed to ophthalmologists prescribing a higher brand-name medication prescription volume than any other prescriber group . Offering lower-cost options to all patients is critical because many patients do not discuss cost concerns with their physicians, even as national expenditures for ophthalmic medications continue to rise …”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Disparities in Cost-Related Barriers to Medication Adherence Among Patients With Glaucoma Enrolled in the National Institutes of Health All of Us Research Program

et al. 2022

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“…In 2011, the estimated direct economic cost to the US health care system for dry eye therapy was $3.8 billion per year and the estimated total societal cost was $55.4 billion per year . More recently, total US per capita expenditure for all ophthalmic medication classes has been shown to be highest for dry eye medications …”

Section: Introductionmentioning

confidence: 99%

“…5 More recently, total US per capita expenditure for all ophthalmic medication classes has been shown to be highest for dry eye medications. 6 Global burden of disease estimates for blindness and vision impairment do not include dry eye prevalence. 7 The TFOS DEWS-II report estimated dry eye to be prevalent in 5% to 50% of populations worldwide, depending on disease definition and other contextual factors.…”

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confidence: 99%

Prevalence and Incidence of Dry Eye and Meibomian Gland Dysfunction in the United States

et al. 2022

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ImportanceDry eye is a common clinical manifestation, a leading cause of eye clinic visits, and a significant societal and personal economic burden in the United States. Meibomian gland dysfunction (MGD) is a major cause of evaporative dry eye.ObjectiveTo conduct a systematic review and meta-analysis to obtain updated estimates of the prevalence and incidence of dry eye and MGD in the United States.Data SourcesOvid MEDLINE and Embase.Study SelectionA search conducted on August 16, 2021, identified studies published between January 1, 2010, and August 16, 2021, with no restrictions regarding participant age or language of publication. Case reports, case series, case-control studies, and interventional studies were excluded.Data Extraction and SynthesisThe conduct of review followed a protocol registered on PROSPERO (CRD42021256934). PRISMA guidelines were followed for reporting. Joanna Briggs Institute and Newcastle Ottawa Scale tools were used to assess risk of bias. Data extraction was conducted by 1 reviewer and verified by another for accuracy. Prevalence of dry eye and MGD were combined in separate meta-analyses using random-effects models.Main Outcomes and MeasuresPrevalence and incidence of dry eye and MGD in the United States. Summary estimates from meta-analysis of dry eye and MGD prevalence with 95% CI and 95% prediction intervals (95% PI).ResultsThirteen studies were included in the systematic review. Dry eye prevalence was reported by 10 studies, dry eye incidence by 2 studies, and MGD prevalence by 3 studies. Meta-analysis estimated a dry eye prevalence of 8.1% (95% CI, 4.9%-13.1%; 95% PI, 0%-98.9%; 3 studies; 9 808 758 participants) and MGD prevalence of 21.2% (95% CI, 7.2%-48.3%; 95% PI, 0%-100%; 3 studies; 19 648 participants). Dry eye incidence was 3.5% in a population 18 years and older and 7.8% in a population aged 68 years and older. No studies reported MGD incidence.Conclusions and RelevanceThis systematic review and meta-analysis demonstrated uncertainty about the prevalence and incidence of dry eye and MGD in the United States. Population-based epidemiological studies that use consistent and validated definitions of dry eye and MGD are needed for higher-certainty estimates of dry eye and MGD prevalence and incidence in the United States.

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“…6 11 With introduction of newer and more costly therapies, an even larger societal and personal economic burden of dry eye can be expected. [12][13][14] Furthermore, despite being a significant public health problem, dry eye remains underdiagnosed, highlighting the…”

Section: Introductionmentioning

confidence: 99%

Prevalence and incidence of dry eye in the USA: a systematic review protocol

et al. 2021

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IntroductionDry eye is a multifactorial chronic condition characterised by tear film insufficiency and instability, and ocular symptoms including foreign body sensation, itching, irritation, soreness and visual disturbance. The prevalence and incidence of dry eye are major determinants of the magnitude of economic and societal costs of the disease. This protocol proposes a systematic review and meta-analysis of the prevalence and incidence of dry eye in the USA.Methods and analysisWorking with an information specialist, we will develop search strategies for Ovid Medline and Embase for population-based cross-sectional and cohort studies involving US-based populations that report the prevalence and/or incidence of dry eye. We will include studies involving persons of all ages from 1 January 2010 to the current date with no language restrictions. We will also hand-search references of included studies, dry eye epidemiology-related systematic reviews, clinical practice guidelines and literature provided by agencies and organisations. Two investigators will independently screen the titles and abstracts, and then full-text reports to determine eligibility. One investigator will extract study data and perform risk of bias assessments using tools designed specifically for prevalence and incidence studies. A second investigator will verify all extracted study data and risk of bias assessments. We will assess heterogeneity, qualitatively and quantitatively. When appropriate, we will meta-analyse prevalence and incidence estimates.Ethics and disseminationThis review does not require approval by an ethics committee because it will use published studies. We will publish our results in a peer-reviewed journal and present at relevant conferences.PROSPERO registration numberCRD42021256934.

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Ophthalmic Medication Expenditures and Out-of-Pocket Spending

Cited by 25 publications

References 29 publications

Racial and Ethnic Disparities in Cost-Related Barriers to Medication Adherence Among Patients With Glaucoma Enrolled in the National Institutes of Health All of Us Research Program

Racial and Ethnic Disparities in Cost-Related Barriers to Medication Adherence Among Patients With Glaucoma Enrolled in the National Institutes of Health All of Us Research Program

Prevalence and Incidence of Dry Eye and Meibomian Gland Dysfunction in the United States

Prevalence and incidence of dry eye in the USA: a systematic review protocol

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