Ozdemir Semra, Wong Tina T, Allingham Robert Rand, Finkelstein Eric A
Health Services and Systems Research Programme, Duke-NUS Medical School Glaucoma Department, Singapore National Eye Centre, Singapore School of Medicine, Duke University, Durham, NC.
Medicine (Baltimore). 2017 Apr;96(15):e6626. doi: 10.1097/MD.0000000000006626.
Sustained-release drug delivery systems that replace the need for daily glaucoma medications will improve outcomes for those who are nonadherent and reduce the inconvenience of having to take medications on a recurring basis.The objective is to estimate uptake (i.e., demand) for a new technology that delivers sustained-release glaucoma medication and to investigate how uptake varies by product attributes, physician recommendations, peer adoption (i.e., percentage of patients seen in a clinic using the new technology), and patient characteristics.In a web-enabled discrete-choice experiment survey, glaucoma patients in the United States were asked to choose between continuing eye drop use or purchasing the new delivery system. In a cross-sectional web-enabled survey, ophthalmologists were asked their likelihood of recommending the new technology based on product and patient characteristics.Study participants were 500 glaucoma patients who were on topical administration of daily eye drops and 155 ophthalmologists who practice in the US.Main outcomes were predicted uptake for patients and likelihood of recommending a new drug delivery system for ophthalmologists. Logistic models were used to analyze the choice data.Uptake was estimated to be 18% at an annual cost of $1000 and to be 24% when the cost was $500. A physician's recommendation increased uptake by 6% to 12%, whereas an increase in peer adoption from 5% to 50% increased uptake by 3% to 7%. Patients aged ≥ 65 and those with lower income were more likely to remain on eye drops. Physicians were more likely to recommend a product if the interval between administrations is 6 months or longer and when long-term safety and efficacy data are available. They were less likely to recommend it to patients with lower income and no adherence problems.Results suggest a significant interest in an injectable solution or other sustained-release alternatives to daily eye drops. However, in this survey, patient uptake was greatly influenced by out-of-pocket cost and the interval between treatment administrations. Few physicians were willing to recommend sustained-release technology if the treatment interval was less than 3 months.
无需每日使用青光眼药物的缓释给药系统，将改善不依从患者的治疗效果，并减少反复用药带来的不便。目标是估计一种新型缓释青光眼药物给药技术的采用率（即需求），并研究采用率如何因产品属性、医生建议、同行采用情况（即在诊所就诊的患者中使用该新技术的百分比）以及患者特征而有所不同。在一项基于网络的离散选择实验调查中，美国的青光眼患者被要求在继续使用眼药水和购买新给药系统之间做出选择。在一项基于网络的横断面调查中，眼科医生被问及基于产品和患者特征推荐该新技术的可能性。研究参与者为500名正在局部使用每日眼药水的青光眼患者以及155名在美国执业的眼科医生。主要结果是预测患者的采用率以及眼科医生推荐新药物给药系统的可能性。使用逻辑模型分析选择数据。估计每年费用为1000美元时采用率为18%，费用为500美元时采用率为24%。医生的推荐使采用率提高了6%至12%，而同行采用率从5%提高到50%则使采用率提高了3%至7%。年龄≥65岁的患者和低收入患者更有可能继续使用眼药水。如果给药间隔为6个月或更长时间且有长期安全性和有效性数据，医生更有可能推荐某种产品。他们不太可能将其推荐给低收入且无依从性问题的患者。结果表明，人们对注射剂或其他替代每日眼药水的缓释替代品有浓厚兴趣。然而，在本次调查中，患者的采用率受自付费用和治疗给药间隔的影响很大。如果治疗间隔少于3个月，很少有医生愿意推荐缓释技术。
