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Abstract：
BACKGROUND: Self-treatment with glaucoma medication (eye drops) has been associated with adherence challenges. Poor adherence results in worse outcomes in terms of visual field loss.
OBJECTIVE: To investigate patterns in medication adherence among Danish patients with glaucoma in relation to selected predictors of adherence, long-term adherence patterns, and long-term societal economic consequences of poor adherence.
METHODS: This register-based study included 30 100 glaucoma patients followed for 10 years between 2000 and 2018. Glaucoma was identified from the Danish national registers by diagnosis of Open Angle Glaucoma and/or by redeemed prescriptions of glaucoma medication. Logistic regression models were applied to estimate patient characteristics related to medical adherence. Diagnosis-related group fees were applied to estimate healthcare costs.
RESULTS: High adherence in the first year(s) of treatment was less likely among men (ORfirst year: 0.78, 95% CI: 0.75 to 0.82), younger individuals and among those with a positive Charlson Comorbidity Index (CCI) score (ORfirst year/CCI≥3: 0.71, 95% CI: 0.63 to 0.80). Adherence in the first year and in the first two years was associated with adherence in the fifth (ORfirst year: 4.55, 95% CI: 4.30 to 4.82/ORfirst two years: 6.47, 95% CI: 6.10 to 6.86) as with adherence in the 10th year with slightly lower estimates. Being medical adherent was related to higher costs related to glaucoma medication after 5 and 10 years comparing with poor adherence, whereas poor adherence was associated with a marked increase in long-term costs for hospital contacts.
CONCLUSIONS: Increasing age, female sex and low comorbidity score are correlated with better adherence to glaucoma treatment. Adherence in the first years of treatment may be a good predictor for future adherence. In the long term, patients with poor adherence are overall more expensive to society in terms of hospital contacts.
OBJECTIVE: To investigate patterns in medication adherence among Danish patients with glaucoma in relation to selected predictors of adherence, long-term adherence patterns, and long-term societal economic consequences of poor adherence.
METHODS: This register-based study included 30 100 glaucoma patients followed for 10 years between 2000 and 2018. Glaucoma was identified from the Danish national registers by diagnosis of Open Angle Glaucoma and/or by redeemed prescriptions of glaucoma medication. Logistic regression models were applied to estimate patient characteristics related to medical adherence. Diagnosis-related group fees were applied to estimate healthcare costs.
RESULTS: High adherence in the first year(s) of treatment was less likely among men (ORfirst year: 0.78, 95% CI: 0.75 to 0.82), younger individuals and among those with a positive Charlson Comorbidity Index (CCI) score (ORfirst year/CCI≥3: 0.71, 95% CI: 0.63 to 0.80). Adherence in the first year and in the first two years was associated with adherence in the fifth (ORfirst year: 4.55, 95% CI: 4.30 to 4.82/ORfirst two years: 6.47, 95% CI: 6.10 to 6.86) as with adherence in the 10th year with slightly lower estimates. Being medical adherent was related to higher costs related to glaucoma medication after 5 and 10 years comparing with poor adherence, whereas poor adherence was associated with a marked increase in long-term costs for hospital contacts.
CONCLUSIONS: Increasing age, female sex and low comorbidity score are correlated with better adherence to glaucoma treatment. Adherence in the first years of treatment may be a good predictor for future adherence. In the long term, patients with poor adherence are overall more expensive to society in terms of hospital contacts.
摘要：
背景：青光眼药物（滴眼液）的自我治疗与依从性挑战有关。较差的依从性导致视野丧失方面的较差结果。
目的：研究丹麦青光眼患者的用药依从性与选择的依从性预测因子的关系，长期坚持模式，以及依从性差的长期社会经济后果。
方法：这项基于注册的研究包括2000年至2018年间随访10年的30100例青光眼患者。通过诊断开角型青光眼和/或兑换青光眼药物的处方，从丹麦国家登记册中确定了青光眼。应用Logistic回归模型来估计与医疗依从性相关的患者特征。诊断相关的团体费用用于估计医疗费用。
结果：男性治疗第一年的高依从性可能性较小（ORfirst年：0.78，95％CI：0.75至0.82），年轻个体和Charlson合并症指数(CCI)评分为阳性的个体(ORfirstyear/CCI≥3:0.71,95%CI:0.63~0.80).第一年和前两年的依从性与第五年的依从性相关（ORfirst年：4.55，95％CI：4.30至4.82/ORfirst两年：6.47，95％CI：6.10至6.86）。与依从性差相比，5年和10年后与青光眼药物治疗相关的费用更高，而依从性差与医院接触者的长期费用显著增加相关.
结论：年龄增长，女性和低合并症评分与更好的青光眼治疗依从性相关。在治疗的头几年坚持可能是一个很好的预测未来的依从性。从长远来看,在医院接触方面，依从性差的患者总体上对社会来说更昂贵。
目的：研究丹麦青光眼患者的用药依从性与选择的依从性预测因子的关系，长期坚持模式，以及依从性差的长期社会经济后果。
方法：这项基于注册的研究包括2000年至2018年间随访10年的30100例青光眼患者。通过诊断开角型青光眼和/或兑换青光眼药物的处方，从丹麦国家登记册中确定了青光眼。应用Logistic回归模型来估计与医疗依从性相关的患者特征。诊断相关的团体费用用于估计医疗费用。
结果：男性治疗第一年的高依从性可能性较小（ORfirst年：0.78，95％CI：0.75至0.82），年轻个体和Charlson合并症指数(CCI)评分为阳性的个体(ORfirstyear/CCI≥3:0.71,95%CI:0.63~0.80).第一年和前两年的依从性与第五年的依从性相关（ORfirst年：4.55，95％CI：4.30至4.82/ORfirst两年：6.47，95％CI：6.10至6.86）。与依从性差相比，5年和10年后与青光眼药物治疗相关的费用更高，而依从性差与医院接触者的长期费用显著增加相关.
结论：年龄增长，女性和低合并症评分与更好的青光眼治疗依从性相关。在治疗的头几年坚持可能是一个很好的预测未来的依从性。从长远来看,在医院接触方面，依从性差的患者总体上对社会来说更昂贵。
